<prompt> Increased level of 5 HIAA is seen in which disease?AlkaptonuriaAlbinismCarcinoid tumorPhenylketonuria  <response>: C Carcinoid tumor?SPECIFIC MARKERS FOR CARCINOID TUMORSoBiochemical Markers: Often elevated in NETs and can be a surrogate marker of symptoms of hormone excess or tumor growth.oChromogranin A levels are elevated in approximately 80 of patients with GI NETs.-Sensitivity is 75 and specificity 85-Falsely positive elevated - PPI or H2 receptor antagonist, hepatic or renal failure.oUrine 5-hydroxyindoleacetic acid 5-HIAA, the primary metabolite of serotonin, is elevated in carcinoid syndrome.-Sensitivity of 35 Specificity of 100.-Abnormal levels 5mg24 hours of 5-HIAA are diagnostic of carcinoid syndrome.-To avoid false positive results - avoid some diet medications?ACTHoLaboratory Evaluation-Carcinoid: 24 hour urinary 5-HIAA raised in carcinoid tumours of the fore-gut and mid-gut but not generally raised in tumors of the hind-gut.-Gastrinoma: Raised basal serum gastrin, high gastric acid secretion.-Insulinoma: Raised fasting insulinglucose ratio, proinsulin or C-peptide.?Carcinoid Syndrome:oCause: Excess serotonin level when the metabolic pathway to 5-HIAA is bypassed.-With extensive liver metastasis-With 1... Pulmonaryovarian carcinoidsoRecurrent diarrhea 70oRight sided endocardial fibroelastosis 35, resulting in tricuspid regurgitation and right heart failure.oDesquamative skin lesions pellagra nausea vomiting fever cutaneous flushing ... 5.oPrognosis: Carcinoid Syndrome has a higher morbidity and mortality than does the tumour itself.oNeuroendocrine cells tumor of intestine especially the appendix. Mostly, asymptomatic. When secrete serotonin result in carcinoid syndrome. Serotonin metabolites urinary 5-HIAA used in screening help in diagnosis along with CT. Primary managed surgically chemotherapy used in secondary.INCREASED LEVEL OF 5 HIAA IS SEEN IN CARCINOID TUMOR-5 Secreted peptide hormonesPancreatic NETClinical manifestation syndromeIslet CellAlpha aGlucagonGlucagonomaDiabetes, dermatitis, NMEBeta bInsulinInsulinomaFasting hypoglycemia, neuroglycopeniaDelta dSomatostatinSomatostatinomaSteatorrhea, cholelithiasis, mild diabetesA-DVIP, other WDHA5-HT ACTHMSHCarcinoidCushing SyndromeHyperpigmentationInteracinar cellFPancreatic polypeptide PPPomaNon-functional or various syndromeEC5-HTCarcinoidCarcinoid syndrome facial flushing, secretory diarrhea, wheezing, right-sided heart valve abnormalitiesVIP, Vasoactive intestinal peptide; 5-HT, serotonin; ACH, andrenocarticotropin; MSH, melanocyte stimulating hormone; WDHA, watery diarrhea, hypokalemia, achlorhydria; EC, enterochromaffin; Modified from: National cancer institute at the national institutes of health, pancreatic neuroendocrine tumors islet cell tumors Treatment PDQ: Health professional version 