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Acid5hidroxiindolaceticPostedBySynevoOnaugust19,2009@4:34pmInMarkeritumorali|NoComments

Informatiigeneralesirecomandaripentrudeterminareaacidului5hidroxiindolaceticurinar

Acidul5hidroxiindolacetic(5HIIA)esteprincipalulmetaboliturinaralserotoninei,oaminabiologicactivaprodusainmodnormaldeceluleleargentafinedintractulgastrointestinal.Functiaacestorceluleconstainreglareacontractieimusculaturiinetedesiaperistaltismuluiintestinal,serotoninafiindinesentaunhormonvasoconstrictor.

Determinarea5HIIAinurinaareutilitateindiagnosticultumorilorcarcinoide,caracterizateprintrocresteresemnificativaaacestuimetaboliturinar2.

Tumorilecarcinoidefacpartedincategoriatumorilorneuroendocrine,avandoincidentascazutainpopulatiesioevolutielenta.Celemaifrecventegrupedevarstaafectatesunt:1525anisi6575ani.Tumorilesedezvoltacelmaiadeseasporadic,insaexistacativafactoriderisc:

neoplaziaendocrinamultipladetip1(MEN1)asociatain10%dincazuricutumorineuroendocrinepulmonare,aletimusuluisistomacului

sindromulvonHippelLindauasociatin15%dincazuricutumoripancreaticedeorigineneuroendocrina

neurofibromatozadetipI(boalavonRecklinghausen)asociataincazurirarecutumoricarcinoidealeduodenului.

Dinpunctdevederehistologic,tumorilecarcinoidesedezvoltadinceluleleenterocromafine(Kulchitsky)infunctiedeloculdeorigineatumoriiseclasificain:

tumoriderivatedinparteacranialaatubuluidigestivprimitiv:pancreatice,duodenale,gastrice,bronsice

tumoriderivatedinparteamedialaatubuluidigestivprimitiv:jejunale,ilealesilanivelulapendicelui

tumoriderivatedinparteacaudalaatubuluidigestivprimitiv:incolonulascendentsirect

tumoricualteorigini:timice,ovariene,renale,mamare.

Tabloulclinicesteadeseanespecific,iarinunelecazuritumorilesuntdepistateintamplatorcuocaziainterventiilorchirurgicalepentruapendicitasiocluzieintestinala.Doar10%dintrepacientiprezintasimptomesisemneclinicetipicesindromuluicarcinoid:flushing,diaree,dureriabdominale,hepatomegalie(metastazelehepaticesuntfrecvente),bronhospasmsiafectarecardiaca(fibrozavalvulara).Simptomelesuntindusedeeliberareadesubstanteneuroendocrine1.Alaturideserotonina,tumorilecarcinoidemaipotdeterminaoexcretiecrescutadetriptofan,5hidroxitriptofansihistamina.Ocazionalsuntsecretatisialticompusicumarfi:ACTH,gastrina[1],insulina,polipeptidintestinalvasoactiv(VIP)sicalcitonina[2].

Productiadeserotoninasimetabolismulacestuihormonsuntinfluentatedetesutuldeorigineatumorii.Astfel,tumorilederivatedinparteamedialaatubuluidigestivprimitiv,cumarficeleileale,continsielibereazadeobiceicantitatimarideserotonina,careinsanusereflectaintrocrestereproportionalaaeliminariide5HIIAinurina,deoareceaceastaestemetabolizataintrocantitateredusa.Pedealtaparte,tumorilebronsice,pancreatice,duodenalesaubiliareproduccantitatimarideserotoninacareesteoxidataintratumoralin5HIIAsiinacestecazuriexcretiametabolituluiestemultmaimaredecatceasuspectataclinic.Carcinoidelerectalerareoriproduccantitaticrescutedeserotoninasau5HIIA.

Existaocorelatieslabaintrenivelulde5HIIAurinarsiseveritateaclinicaasindromuluicarcinoid.Studiirecenteconfirmainsautilitateasacafactordeprognosticalbolii5.

Pregatirepacientsevaevitaconsumuldebanane,ananas,prune,kiwi,pepenegalben,nuci,cacao,rosii,avocado,vinetecu72oreinaintearecoltarii(deoareceacestealimentecontinserotonina).Deasemeneaestedepreferatsaseintrerupamedicatiacarepoateproduceinterferentecu3zileinaintearecoltarii:acetaminofen,

salicilati,fenacetin,naproxen,clorpromazina,imipraminasiinhibitoridemonoaminoxidaza24.

Specimenrecoltaturinadin24ore:laora7dimineatapacientulurineazasinuretineaceastaurinaapoicolecteazaintrunvascuratde23litritoateemisiuniledeurinapanalaora7dimineatainziuaurmatoare,inclusivomogenizeaza(prinagitare)urinarecoltatamasoaraintreagacantitateretineaprox.10mL,inpahardeplasticdeunicafolosintapentruurina.Probasetinela28Cintimpulcolectariisiulterior,panaselucreazaefectiv4.

Recipientderecoltarevasde23litrisipahardeplasticdeunicafolosintapentruurina,pecaresenoteazacantitateatotaladeurinadin24deore4.

Cantitaterecoltata10mL4.

Cauzederespingereaprobeispecimencarenuafostpastratla28C4.

Prelucrarenecesaraduparecoltareestedepreferatsaselucrezeimediatdacacestlucrunuesteposibil,probasepoatestocala28C,dupaceinprealabilseadaugaacidclorhidricconcentratpanaseajungelaunpH25mg/24oreindicatumoricarcinoidemari,adeseacumetastaze2.Obtinereaunorvaloridegranitasauusorcrescuteimpunerepetarearecoltariiprobei,curespectareastrictaadieteirecomandatesievitareamedicamentelorcarepotproduceinterferente.Atuncicandunpacientcususpiciuneclinicamaredesindrom

carcinoidprezintavaloride5HIIAnormalesaudegranita,trebuieluateinconsiderare2posibilitati:fietumoraproducecantitatimarideserotoninacarenuestemetabolizatasiinacestcazdozareaserotonineisericevaajutalastabilireadiagnosticului,fiesecretiade5HIIAesteintermitenta,situatieincaretrebuierecoltatemaimulteprobedeurinapentruapuneinevidentaanomalia5.

Cresteriusoarede5HIIAsemaipotintalniinspruenontropical.Deasemeneasepotinregistravaloricrescutesilapacientiicumalabsorbtienetratata,careprezintaniveluriridicatedemetabolitiurinariaitriptofanului,cumarficeicuboalaceliaca,boalaWhipplesifibrozachistica5.

Valoriscazutede5HIIAsuntintalnitelapacientiicuinsuficientarenala,rezectiedeintestinsubtire,fenilcetonurie,boalaHartnup,mastocitoza2.

Limitesiinterferente

5HIIApoateprezentavalorinormalelapacientiicutumoricarcinoidenonmetastaticesichiarsilaopartedinceicusindromcarcinoid,maialesdacadiareeaesteabsenta.

Uniipacienticusindromcarcinoidexcretaaciziindolicinonhidroxilaticarenusuntmasuratiladeterminarea5HIIA5.

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.InAManualofLaboratoryandDiagnosticTests.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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