Development, validation and standardization of urinary 5-hydroxyindoleacetic acid determination by LC-MS/MS for implementation in quality-controlled environments

Carcinoid tumors referred to neuroendocrine neoplasms that often are indolent and may not became clinical apparent until there has been metastatic spread. Urinary 5-hydroxyindoleacetic acid (5-HIAA) was recommended as a first-line screening biomarker for the diagnosis and follow-up of carcinoid tumors. The measurement of this analyte is conventionally performed by spectrophotometer or high performance liquid chromatography, and has switched to liquid chromatography-tandem mass spectrometry (LC-MS/MS) recently. In this study, a fast, simple and reliable LC-MS/MS method has been developed and validated for 24 h urinary 5-HIAA determination and the quality assurance referring to post-implementation monitoring has been explored. 50 μL of urine was mixed with 200 μL of a 50% methanol/water solution containing the internal standard 5-HIAA-d5. The mixture was centrifuged and the supernatant was used for direct analysis by LC-MS/MS. The retention time of 5-HIAA is 2.37 min and a total run time is 4 min. This method was validated for excellent linearity from 0.675 to 43.3 μM with CVs ≤ 6.64% and good recovery in the range of 87.1%-107%. No obvious matrix effect was observed. Intra- and inter-day imprecision were below 3.95% and 4.66% respectively. The reference interval of 24-hour urinary 5-HIAA in Chinese adults was established. The quality assurance could ensure reliable and comparable results in routine clinical testing. Thus, this fast, simple and reliable LC-MS/MS method could be proposed as a tool for clinical testing of urinary 5-HIAA in quality-controlled environments.