Test ID: HIAA
5-Hydroxyindoleacetic Acid (5-HIAA), Urine
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Biochemical diagnosis and monitoring of intestinal carcinoid syndrome
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
5-OH-Indoleacetic Acid
Carcinoid Syndrome
HIAA (Hydroxyindoleacetic Acid)
Serotonin Metabolite
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Plastic, 10-mL urine tube (Supply T068)
Specimen Volume: 5 mL
Collection Instructions:
1. Collect a 24-hour urine specimen.
2. Add 25 mL of 50% acetic acid as preservative at start of collection. Use 15 mL of 50% acetic acid for children <5 years old.
3. Patients should not eat avocados, bananas, butternuts, cantaloupe, dates, eggplant, grapefruit, hickory nuts, honeydew melon, kiwifruit, melons, nuts, pecans, pineapple, plantains, plums, tomatoes and tomato products, or walnuts which are high in serotonin for 48 hours before or during collection.
4. Certain medications, such as L-dopa, acetaminophen, salicylates, and cough syrup containing guaifenesin must also be avoided.
Additional Information:
1. 24-hour volume is required.
2. See Urine Preservatives in Special Instructions for multiple collections.
Urine Preservative Collection Options
| Ambient | No |
| Refrigerated | Yes |
| Frozen | Yes |
| 6N HCl | Yes (30 mL) |
| 50% Acetic Acid | Preferred |
| Na2CO3 | Yes (5 g) |
| Toluene | Yes (30 mL) |
| 6N HNO3 | Yes (15 mL) |
| Boric Acid | Yes (10 g) |
| Thymol | Yes (10%) |
Forms: If not ordering electronically, submit a General Request Form (Supply T239) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 56 days |
| Frozen | 365 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
5-Hydroxyindoleacetic acid (5-HIAA) is the major metabolite of serotonin and is excreted in the urine. Intestinal carcinoid tumors along with neuroendocrine tumors can produce excess amounts of 5-HIAA and serotonin especially in individuals with carcinoid syndrome. Carcinoid syndrome is characterized by carcinoid tumors, flushing, heart disease, and hepatomegaly. Normally 1% to 3% of dietary tryptophan is metabolized to serotonin. However, as much as 50% of tryptophan is converted to serotonin in patients with the intestinal carcinoid syndrome.
Measurement of 5-HIAA in a 24-hour urine specimen can diagnose carcinoid disease with a high specificity.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Adults: < or =8 mg/24 hours
Interpretation Provides information to assist in interpretation of the test results
Elevated excretion of 5-hydroxyindoleacetic acid is a probable indicator of the presence of a serotonin-producing tumor, if pharmacological and dietary artifacts have been ruled out.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Intake of food with a high content of serotonin (avocados, bananas, plums, walnuts, pineapple, eggplant, plantains, tomatoes and tomato products, hickory nuts, kiwifruit, dates, grapefruit, butternuts, melons, nuts, pecans, cantaloupe, or honeydew melon) within 48 hours of the urine collection could result in falsely elevated 5-hydroxyindoleacetic acid (5-HIAA) excretion.
Numerous drugs affect the excretion of 5-HIAA by different mechanisms, including increased serotonin synthesis, metabolism, and release and inhibition of uptake. See "Update on Serotonin" in the August 2006 Communique' in Publications, as well as Clinical References #3 and #4, for a detailed list of potentially interfering drugs.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. de Herder W: Biochemistry of neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab 2007 Mar;21(1):33-41
2. Manini P, Andreoli R, Cavazzini S, et al: Liquid chromatography-electrospray tandem mass spectrometry of acidic monoamine metabolites. J Chromatogr B Biomed Sci Appl 2000 July 21;744(2):423-431
3. Mashige F, Matsushima Y, Kanazawa H, et al: Acidic catecholamine metabolites and 5-hydroxyindoleacetic acid in urine: the influence of diet. Ann Clin Biochem 1996;33:43-49
4. Mills K: Serotonin syndrome - A clinical update. Crit Care Clin 1997;13:763-783
5. Serotonin syndrome. In POISINDEX System. Edited by RK Klasco, CR Gelman, LT Hill. Greenwood Village, Colorado, Micromedex, 2002
Method Description Describes how the test is performed and provides a method-specific reference
5-Hydroxyindoleacetic acid (5-HIAA) is measured by C18 solid phase extraction (SPE) of an aliquot from a 24-hour urine collection and liquid chromatography/tandem mass spectrometry analysis using an amide-C16 high performance liquid chromatography column at a flow rate of 1.0 mL/min. 5-HIAA elutes apart from the bulk of the specimen matrix at a retention time of approximately 1.5 minutes. 5-HIAA is quantitated using a custom synthesized stable isotope labeled internal standard (d6-5-HIAA) from calibration over a concentration range 0.5 to 150 mg/L.(Kroll CA, Magera MJ, Helgeson JK, et al: A liquid chromatography-tandem mass spectrometry method for the determination of 5-hydroxyindole-3-acetic acid in urine. Clin Chem 2002;48:2049-2051)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; 11 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
83497
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 9248 | 5-Hydroxyindoleacetic Acid, U | 1695-6 |
| TM35 | Collection Duration | 13362-9 |
| VL33 | Urine Volume | 28009-9 |
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