{"id":225,"date":"2025-06-11T12:48:45","date_gmt":"2025-06-11T12:48:45","guid":{"rendered":"https:\/\/analizesanocare.ro\/?post_type=product&#038;p=225"},"modified":"2025-08-08T13:57:28","modified_gmt":"2025-08-08T13:57:28","slug":"acid-5-hidroxi-indolacetic","status":"publish","type":"product","link":"https:\/\/analizesanocare.ro\/en\/analiz\u0103\/acid-5-hidroxi-indolacetic\/","title":{"rendered":"Acid 5-hidroxi-indolacetic"},"content":{"rendered":"<div class=\"info-content content-informatii-generale\">\n<h2><strong>Informa\u0163ii generale \u015fi recomand\u0103ri: Acid 5-hidroxi-indolacetic<\/strong><\/h2>\n<p>Acidul 5-hidroxi-indolacetic (5-HIIA) este principalul metabolit urinar al serotoninei, o amin\u0103 biologic activ\u0103 produs\u0103 \u00een mod normal de celulele argentafine din tractul gastrointestinal. Func\u0163ia acestor celule const\u0103 \u00een reglarea contrac\u0163iei musculaturii netede \u015fi a peristaltismului intestinal, serotonina fiind \u00een esen\u0163\u0103 un hormon vasoconstrictor.<\/p>\n<p>Determinarea 5-HIIA \u00een urin\u0103 are utilitate \u00een diagnosticul tumorilor carcinoide, caracterizate printr-o cre\u015ftere semnificativ\u0103 a acestui metabolit urinar<sup>2<\/sup>.<\/p>\n<p>Tumorile carcinoide fac parte din categoria tumorilor neuroendocrine, av\u00e2nd o inciden\u0163\u0103 sc\u0103zut\u0103 \u00een popula\u0163ie \u015fi o evolu\u0163ie lent\u0103. Cele mai frecvente grupe de v\u00e2rst\u0103 afectate sunt: 15-25 ani \u015fi 65-75 ani. Tumorile se dezvolt\u0103 cel mai adesea sporadic, \u00eens\u0103 exist\u0103 c\u00e2\u0163iva factori de risc:<\/p>\n<ul>\n<li>neoplazia endocrin\u0103 multipl\u0103 de tip 1 (MEN1) asociat\u0103 \u00een 10% din cazuri cu tumori neuroendocrine pulmonare, ale timusului \u015fi stomacului;<\/li>\n<li>sindromul von Hippel-Lindau asociat \u00een 15% din cazuri cu tumori pancreatice de origine neuroendocrin\u0103;<\/li>\n<li>neurofibromatoza de tip I (boala von Recklinghausen) asociat\u0103 \u00een cazuri rare cu tumori carcinoide ale duodenului.<\/li>\n<\/ul>\n<p>Din punct de vedere histologic, tumorile carcinoide se dezvolt\u0103 din celulele enterocromafine (Kulchitsky); \u00een func\u0163ie de locul de origine a tumorii se clasific\u0103 \u00een:<\/p>\n<ul>\n<li>tumori derivate din partea cranial\u0103 a tubului digestiv primitiv: pancreatice, duodenale, gastrice, bron\u015fice;<\/li>\n<li>tumori derivate din partea medial\u0103 a tubului digestiv primitiv: jejunale, ileale \u015fi la nivelul apendicelui;<\/li>\n<li>tumori derivate din partea caudal\u0103 a tubului digestiv primitiv: \u00een colonul ascendent \u015fi rect;<\/li>\n<li>tumori cu alte origini: timice, ovariene, renale, mamare.<\/li>\n<\/ul>\n<p>Tabloul clinic este adesea nespecific, iar \u00een unele cazuri tumorile sunt depistate \u00eent\u00e2mpl\u0103tor cu ocazia interven\u0163iilor chirurgicale pentru apendicit\u0103 \u015fi ocluzie intestinal\u0103. Doar 10% dintre pacien\u0163i prezint\u0103 simptome \u015fi semne clinice tipice sindromului carcinoid: flushing, <a href=\"https:\/\/www.synevo.ro\/sindromul-diareic-forme-de-diaree\/\" data-wpel-link=\"internal\">diaree<\/a>, dureri abdominale, hepatomegalie (metastazele hepatice sunt frecvente), bronhospasm \u015fi afectare cardiac\u0103 (fibroz\u0103 valvular\u0103). Simptomele sunt induse de eliberarea de substan\u0163e neuroendocrine<sup>1<\/sup>. Al\u0103turi de serotonin\u0103, tumorile carcinoide mai pot determina o excre\u0163ie crescut\u0103 de triptofan, 5-hidroxitriptofan \u015fi histamin\u0103. Ocazional sunt secreta\u0163i \u015fi al\u0163i compu\u015fi cum ar fi: ACTH, gastrin\u0103, insulin\u0103, polipeptid intestinal vasoactiv (VIP) \u015fi calcitonin\u0103.<\/p>\n<p>Produc\u0163ia de serotonin\u0103 \u015fi metabolismul acestui hormon sunt influen\u0163ate de \u0163esutul de origine a tumorii. Astfel, tumorile derivate din partea medial\u0103 a tubului digestiv primitiv, cum ar fi cele ileale, con\u0163in \u015fi elibereaz\u0103 de obicei cantit\u0103\u0163i mari de serotonin\u0103, care \u00eens\u0103 nu se reflect\u0103 \u00eentr-o cre\u015ftere propor\u0163ional\u0103 a elimin\u0103rii de 5-HIIA \u00een urin\u0103, deoarece aceasta este metabolizat\u0103 \u00eentr-o cantitate redus\u0103. Pe de alt\u0103 parte, tumorile bron\u015fice, pancreatice, duodenale sau biliare produc cantit\u0103\u0163i mari de serotonin\u0103 care este oxidat\u0103 intratumoral \u00een 5-HIIA \u015fi \u00een aceste cazuri excre\u0163ia metabolitului este mult mai mare dec\u00e2t cea suspectat\u0103 clinic. Carcinoidele rectale rareori produc cantit\u0103\u0163i crescute de serotonin\u0103 sau 5-HIIA.<\/p>\n<p>Exist\u0103 o corela\u0163ie slab\u0103 \u00eentre nivelul de 5-HIIA urinar \u015fi severitatea clinic\u0103 a sindromului carcinoid. Studii recente confirm\u0103 \u00eens\u0103 utilitatea sa ca factor de prognostic al bolii<sup>5<\/sup>.<\/p>\n<p><strong>Preg\u0103tire pacient\u00ad <\/strong>\u2013 se va evita consumul de banane, ananas, prune, kiwi, pepene galben, nuci, cacao, ro\u015fii, avocado, vinete cu 72 ore \u00eenaintea recolt\u0103rii (deoarece aceste alimente con\u0163in serotonin\u0103). De asemenea este de preferat s\u0103 se \u00eentrerup\u0103 medica\u0163ia care poate produce interferen\u0163e cu 3 zile \u00eenaintea recolt\u0103rii: acetaminofen, salicila\u0163i, fenacetin, naproxen, clorpromazin\u0103, imipramin\u0103 \u015fi inhibitori de monoaminoxidaz\u0103<sup>2;4<\/sup>.<\/p>\n<p><strong>Specimen recoltat\u00ad <\/strong>\u2013 urina din 24 ore: la ora 7 diminea\u0163a pacientul urineaz\u0103 \u015fi nu re\u0163ine aceast\u0103 urin\u0103; apoi colecteaz\u0103 \u00eentr-un vas curat de 2-3 litri toate emisiunile de urin\u0103 p\u00e2n\u0103 la ora 7 diminea\u0163a \u00een ziua urm\u0103toare, inclusiv; omogenizeaz\u0103 (prin agitare) urina recoltat\u0103; m\u0103soar\u0103 \u00eentreaga cantitate; re\u0163ine aprox. 10 mL, \u00een pahar de plastic de unic\u0103 folosin\u0163\u0103 pentru urin\u0103. Proba se \u0163ine la 2-8\u00baC \u00een timpul colect\u0103rii<sup>4<\/sup>.<\/p>\n<p><strong>Recipient de recoltare <\/strong>\u2013 vas de 2-3 litri \u015fi pahar de plastic de unic\u0103 folosin\u0163\u0103 pentru urin\u0103, pe care se noteaz\u0103 cantitatea total\u0103 de urin\u0103 din 24 de ore<sup>4<\/sup>.<\/p>\n<p><strong>Cantitate recoltat\u0103 <\/strong>\u2013 10 mL<sup>4<\/sup>.<\/p>\n<p><strong>Prelucrare necesar\u0103 dup\u0103 recoltare <\/strong>\u2013 se adauga HCl (32%) pana valoarea Ph-ului probei ajunge la 1-2<sup>4<\/sup>.<\/p>\n<p><strong>Cauze de respingere a probei <\/strong>\u2013 specimen care nu a fost p\u0103strat la temperaturile la 2-8\u00b0C.<\/p>\n<p><strong>Stabilitate prob\u0103 <\/strong>\u2013 dupa prelucrare, 1 zi 2-8\u00b0C, 1 luna la -20\u00b0C<sup>4<\/sup>.<\/p>\n<p><strong>Metod\u0103 <\/strong>\u2013 HPLC<sup>4<\/sup>.<\/p>\n<h2><strong>Valori de referin\u0163\u0103 Acid 5-hidroxi-indolacetic<\/strong><\/h2>\n<p>2-8 mg\/24 ore<sup>4<\/sup>.<\/p>\n<h2><strong>Interpretarea rezultatelor Acid 5-hidroxi-indolacetic<\/strong><\/h2>\n<p>Niveluri &gt;25 mg\/24 ore indic\u0103 tumori carcinoide mari, adesea cu metastaze<sup>2<\/sup>. Ob\u0163inerea unor valori de grani\u0163\u0103 sau u\u015for crescute impune repetarea recolt\u0103rii probei, cu respectarea strict\u0103 a dietei recomandate \u015fi evitarea medicamentelor care pot produce interferen\u0163e. Atunci c\u00e2nd un pacient cu suspiciune clinic\u0103 mare de sindrom carcinoid prezint\u0103 valori de 5-HIIA normale sau de grani\u0163\u0103, trebuie luate \u00een considerare 2 posibilit\u0103\u0163i: fie tumora produce cantit\u0103\u0163i mari de serotonin\u0103 care nu este metabolizat\u0103 \u015fi in acest caz dozarea serotoninei serice va ajuta la stabilirea diagnosticului, fie secre\u0163ia de 5-HIIA este intermitent\u0103, situa\u0163ie \u00een care trebuie recoltate mai multe probe de urin\u0103 pentru a pune \u00een eviden\u0163\u0103 anomalia<sup>5<\/sup>.<\/p>\n<p>Cre\u015fteri u\u015foare de 5-HIIA se mai pot \u00eent\u00e2lni \u00een sprue non-tropical. De asemenea se pot \u00eenregistra valori crescute \u015fi la pacien\u0163ii cu malabsorb\u0163ie netratat\u0103, care prezint\u0103 niveluri ridicate de metaboli\u0163i urinari ai triptofanului, cum ar fi cei cu boal\u0103 Whipple \u015fi fibroz\u0103 chistic\u0103<sup>5<\/sup>.<\/p>\n<p>Valori sc\u0103zute de 5-HIIA sunt \u00eent\u00e2lnite la pacien\u0163ii cu insuficien\u0163\u0103 renal\u0103, rezec\u0163ie de intestin sub\u0163ire, fenilcetonurie, boal\u0103 Hartnup, mastocitoz\u0103<sup>2<\/sup>.<\/p>\n<p><strong>Limite \u015fi interferen\u0163e<\/strong><\/p>\n<div>5-HIIA poate prezenta valori normale la pacien\u0163ii cu tumori carcinoide non-metastatice \u015fi chiar \u015fi la o parte din cei cu sindrom carcinoid, mai ales dac\u0103 diareea este absent\u0103.<\/div>\n<div>Unii pacien\u0163i cu sindrom carcinoid excret\u0103 acizi indolici non-hidroxila\u0163i care nu sunt m\u0103sura\u0163i la determinarea 5-HIIA<sup>5<\/sup>.<\/div>\n<div>Prin dozarea serotoninei serice se pot diagnostica tumori carcinoide la care determinarea 5-HIIA a dat rezultate negative<sup>2;5<\/sup>.<\/div>\n<ul>\n<li>Medicamente<\/li>\n<\/ul>\n<p><u>Cre\u015fteri<\/u>: acetaminofen, clordiazepoxid, cisplatin, clorpromazin\u0103, diazepam, efedrin\u0103, fenobarbital, fentolamin\u0103, flurazepam, fluorouracil, guaifenesin, melfalan, methocarbamol, naproxen, sulfasalazin\u0103, rezerpin\u0103<sup>3<\/sup>.<\/p>\n<p><u>Sc\u0103deri<\/u>: aspirin\u0103, clorpromazin, corticotropin, imipramin\u0103, inhibitori de MAO, interferon alfa-2a, izoniazid\u0103, levodopa, metildopa, octreotid, promazin\u0103, streptozocin<sup>3<\/sup>.<\/p>\n<h2><strong>Bibliografie\u00a0<\/strong><\/h2>\n<ol>\n<li>ARUP Laboratories. Physician Guide: Carcinoid Tumors. www.aruplab.com. 2016. Ref Type: Internet Communication.<\/li>\n<li>Frances Fischbach. Urine Testing. In A Manual of Laboratory and Diagnostic Test. Lippincott Williams &amp; Wilkins, USA, 8 Ed., 2009, 262-264.<\/li>\n<li>Frances Fischbach. Effects of the Most Commonly Used Drugs on Frequently Ordered Laboratory Tests. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp; Wilkins, USA, 8 Ed., 2009, 1243.<\/li>\n<li>Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate. 2016. Ref Type: Catalog.<\/li>\n<li>Laboratory Corporation of America. Directory of Services and Interpretive Guide. 5-Hydroxyindoleacetic Acid (HIAA), Quantitative, 24-Hour Urine. <a href=\"http:\/\/www.labcorp.com\/\" target=\"_blank\" rel=\"noopener nofollow external noreferrer\" data-wpel-link=\"external\">www.labcorp.com<\/a> 2016. Ref Type: Internet Communication.<\/li>\n<\/ol>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Informa\u0163ii generale \u015fi recomand\u0103ri: Acid 5-hidroxi-indolacetic Acidul 5-hidroxi-indolacetic (5-HIIA) este principalul metabolit urinar al serotoninei, o amin\u0103 biologic activ\u0103 produs\u0103 \u00een mod normal de celulele argentafine din tractul gastrointestinal. Func\u0163ia acestor celule const\u0103 \u00een reglarea contrac\u0163iei musculaturii netede \u015fi a peristaltismului intestinal, serotonina fiind \u00een esen\u0163\u0103 un hormon vasoconstrictor. Determinarea 5-HIIA \u00een urin\u0103 are utilitate [&hellip;]<\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false},"product_brand":[],"product_cat":[37],"product_tag":[],"class_list":["post-225","product","type-product","status-publish","product_cat-markeri-tumorali","first","instock","shipping-taxable","purchasable","product-type-simple"],"acf":[],"_links":{"self":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product\/225","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/types\/product"}],"wp:attachment":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/media?parent=225"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_brand?post=225"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_cat?post=225"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_tag?post=225"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}