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Acid5hidroxiindolacetic
PostedBySynevoOnaugust19,2009@4:34pmInMarkeritumorali|NoComments

Informatiigeneralesirecomandaripentrudeterminareaacidului5hidroxiindolaceticurinar
Acidul5hidroxiindolacetic(5HIIA)esteprincipalulmetaboliturinaralserotoninei,oaminabiologicactivaprodusa
inmodnormaldeceluleleargentafinedintractulgastrointestinal.Functiaacestorceluleconstainreglarea
contractieimusculaturiinetedesiaperistaltismuluiintestinal,serotoninafiindinesentaunhormonvasoconstrictor.
Determinarea5HIIAinurinaareutilitateindiagnosticultumorilorcarcinoide,caracterizateprintrocrestere
semnificativaaacestuimetaboliturinar2.
Tumorilecarcinoidefacpartedincategoriatumorilorneuroendocrine,avandoincidentascazutainpopulatiesio
evolutielenta.Celemaifrecventegrupedevarstaafectatesunt:1525anisi6575ani.Tumorilesedezvoltacel
maiadeseasporadic,insaexistacativafactoriderisc:
neoplaziaendocrinamultipladetip1(MEN1)asociatain10%dincazuricutumorineuroendocrinepulmonare,
aletimusuluisistomacului
sindromulvonHippelLindauasociatin15%dincazuricutumoripancreaticedeorigineneuroendocrina
neurofibromatozadetipI(boalavonRecklinghausen)asociataincazurirarecutumoricarcinoideale
duodenului.
Dinpunctdevederehistologic,tumorilecarcinoidesedezvoltadinceluleleenterocromafine(Kulchitsky)infunctie
deloculdeorigineatumoriiseclasificain:

tumoriderivatedinparteacranialaatubuluidigestivprimitiv:pancreatice,duodenale,gastrice,bronsice
tumoriderivatedinparteamedialaatubuluidigestivprimitiv:jejunale,ilealesilanivelulapendicelui
tumoriderivatedinparteacaudalaatubuluidigestivprimitiv:incolonulascendentsirect
tumoricualteorigini:timice,ovariene,renale,mamare.
Tabloulclinicesteadeseanespecific,iarinunelecazuritumorilesuntdepistateintamplatorcuocaziainterventiilor
chirurgicalepentruapendicitasiocluzieintestinala.Doar10%dintrepacientiprezintasimptomesisemneclinice
tipicesindromuluicarcinoid:flushing,diaree,dureriabdominale,hepatomegalie(metastazelehepaticesunt
frecvente),bronhospasmsiafectarecardiaca(fibrozavalvulara).Simptomelesuntindusedeeliberareade
substanteneuroendocrine1.Alaturideserotonina,tumorilecarcinoidemaipotdeterminaoexcretiecrescutade
triptofan,5hidroxitriptofansihistamina.Ocazionalsuntsecretatisialticompusicumarfi:ACTH,gastrina[1],
insulina,polipeptidintestinalvasoactiv(VIP)sicalcitonina[2].
Productiadeserotoninasimetabolismulacestuihormonsuntinfluentatedetesutuldeorigineatumorii.Astfel,
tumorilederivatedinparteamedialaatubuluidigestivprimitiv,cumarficeleileale,continsielibereazadeobicei
cantitatimarideserotonina,careinsanusereflectaintrocrestereproportionalaaeliminariide5HIIAinurina,
deoareceaceastaestemetabolizataintrocantitateredusa.Pedealtaparte,tumorilebronsice,pancreatice,
duodenalesaubiliareproduccantitatimarideserotoninacareesteoxidataintratumoralin5HIIAsiinacestecazuri
excretiametabolituluiestemultmaimaredecatceasuspectataclinic.Carcinoidelerectalerareoriproduccantitati
crescutedeserotoninasau5HIIA.
Existaocorelatieslabaintrenivelulde5HIIAurinarsiseveritateaclinicaasindromuluicarcinoid.Studiirecente
confirmainsautilitateasacafactordeprognosticalbolii5.
Pregatirepacient
sevaevitaconsumuldebanane,ananas,prune,kiwi,pepenegalben,nuci,cacao,rosii,
avocado,vinetecu72oreinaintearecoltarii(deoareceacestealimentecontinserotonina).Deasemeneaestede
preferatsaseintrerupamedicatiacarepoateproduceinterferentecu3zileinaintearecoltarii:acetaminofen,

salicilati,fenacetin,naproxen,clorpromazina,imipraminasiinhibitoridemonoaminoxidaza24.
Specimenrecoltat
urinadin24ore:laora7dimineatapacientulurineazasinuretineaceastaurinaapoi
colecteazaintrunvascuratde23litritoateemisiuniledeurinapanalaora7dimineatainziuaurmatoare,
inclusivomogenizeaza(prinagitare)urinarecoltatamasoaraintreagacantitateretineaprox.10mL,inpaharde
plasticdeunicafolosintapentruurina.Probasetinela28Cintimpulcolectariisiulterior,panaselucreaza
efectiv4.
Recipientderecoltarevasde23litrisipahardeplasticdeunicafolosintapentruurina,pecaresenoteaza
cantitateatotaladeurinadin24deore4.
Cantitaterecoltata10mL4.
Cauzederespingereaprobeispecimencarenuafostpastratla28C4.
Prelucrarenecesaraduparecoltareestedepreferatsaselucrezeimediatdacacestlucrunuesteposibil,
probasepoatestocala28C,dupaceinprealabilseadaugaacidclorhidricconcentratpanaseajungelaunpH
<34.
Stabilitateproba1saptamanala28C4.
Metodacromatografiedelichidesubinaltapresiune(HPLC)4.
Valoridereferinta29mg/24ore4.
Interpretarearezultatelor
Niveluri>25mg/24oreindicatumoricarcinoidemari,adeseacumetastaze2.Obtinereaunorvaloridegranitasau
usorcrescuteimpunerepetarearecoltariiprobei,curespectareastrictaadieteirecomandatesievitarea
medicamentelorcarepotproduceinterferente.Atuncicandunpacientcususpiciuneclinicamaredesindrom

carcinoidprezintavaloride5HIIAnormalesaudegranita,trebuieluateinconsiderare2posibilitati:fietumora
producecantitatimarideserotoninacarenuestemetabolizatasiinacestcazdozareaserotonineisericevaajutala
stabilireadiagnosticului,fiesecretiade5HIIAesteintermitenta,situatieincaretrebuierecoltatemaimulteprobe
deurinapentruapuneinevidentaanomalia5.
Cresteriusoarede5HIIAsemaipotintalniinspruenontropical.Deasemeneasepotinregistravaloricrescutesi
lapacientiicumalabsorbtienetratata,careprezintaniveluriridicatedemetabolitiurinariaitriptofanului,cumarfi
ceicuboalaceliaca,boalaWhipplesifibrozachistica5.
Valoriscazutede5HIIAsuntintalnitelapacientiicuinsuficientarenala,rezectiedeintestinsubtire,fenilcetonurie,
boalaHartnup,mastocitoza2.
Limitesiinterferente
5HIIApoateprezentavalorinormalelapacientiicutumoricarcinoidenonmetastaticesichiarsilaopartedincei
cusindromcarcinoid,maialesdacadiareeaesteabsenta.
Uniipacienticusindromcarcinoidexcretaaciziindolicinonhidroxilaticarenusuntmasuratiladeterminarea5
HIIA5.
Prindozareaserotonineisericesepotdiagnosticatumoricarcinoidelacaredeterminarea5HIIAadatrezultate[3]
negative25.
Medicamente
Cresteri:acetaminofen,clordiazepoxid,cisplatin,clorpromazina,diazepam,efedrina,fenobarbital,fentolamina,
flurazepam,fluorouracil,guaifenesin,melfalan,methocarbamol,naproxen,sulfasalazina,rezerpina3.
Scaderi:aspirina,clorpromazin,corticotropin,imipramina,inhibitorideMAO,interferonalfa2a,izoniazida,
levodopa,metildopa,octreotid,promazina,streptozocin3.


Bibliografie

1.ARUPLaboratories.PhysicianGuide:CarcinoidTumors.www.aruplab.com.2010.RefType:InternetCommunication.
2.FrancesFischbach.UrineTesting.InAManualofLaboratoryandDiagnosticTest.LippincottWilliams&Wilkins,USA,8Ed.,
2009,262264.
3.FrancesFischbach.EffectsoftheMostCommonlyUsedDrugsonFrequentlyOrderedLaboratoryTests.InAManualof
LaboratoryandDiagnosticTests.LippincottWilliams&Wilkins,USA,8Ed.,2009,1243.
4.LaboratorSynevo.Referinelespecificetehnologieidelucruutilizate.2014.RefType:Catalog.
5.LaboratoryCorporationofAmerica.DirectoryofServicesandInterpretiveGuide.5HydroxyindoleaceticAcid(HIAA),
Quantitative,24HourUrine.www.labcorp.com[4]2014.RefType:InternetCommunication.

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[4]www.labcorp.com:http://www.labcorp.com/

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