Urinary sampling for 5HIAA and metanephrines determination: revisiting the recommendations

Context: Biogenic amines such as 5-hydroxy-indole acetic acid (5HIAA) the main metabolite of serotonin or metanephrines (catecholamines metabolites) are used as biomarkers of neuroendocrine tumours.

Objective: To re-evaluate the recommendations for urinary sampling (Preservatives, diet, drugs, etc.) as many of the reported analytical interferences supporting these recommendations are related to obsolete assays.

Methods: Bibliographic analysis of old and modern assays concerning preservation, extraction, assay and interferences.

Results: 5HIAA may degrade as soon as urine is excreted. Thus, acids as Preservatives (hydrochloric or acetic acid) have to be immediately added. Care should be taken not to decrease the pH under 2. Urine preservative for metanephrine assays is not mandatory. Diets including serotonin-, tryptophan- and dopamine-rich foods have to be avoided depending on the biomarkers investigated (bananas, plantain, nuts, etc.). Tryptophan-rich over-the-counter formulas have to be prohibited when 5HIAA has to be assayed. Acetaminophen may interfere with electrochemical detection depending on high-pressure liquid chromatography (HPLC) parameters. No interference is known with mass spectrometric assays but with the one described for metanephrines determination. Some drugs interfere however with serotonin and catecholamines secretion and/or metabolism (Monoamine Oxidase inhibitors, serotonin or dopamine recapture inhibitors, etc.).

Conclusion: Revisited recommendations are provided for the diet, the drugs and the Preservatives before HPLC coupled with electrochemical and mass spectrometry assays.