Elevated Urinary 5-HIAA; Which Drug? - USMLE Forums
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Old 10-19-2012
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Drug Elevated Urinary 5-HIAA; Which Drug?

A 46 yr old male comes to physician for evaluation of diarrhea....his complaints include recent weight loss of 4kgs, profuse sweating and feeling warmth at most of times..his abdominal cramps and diarrhea makes him sometimes be off from work...his stool findings contain no rbc, wbc, or ova of parasites...on further evaluation, physician finds occasional wheezes in both lung fields and a murmur in tricuspid area..and his urine examination reveals elevated urinary 5-HIAA...which is the appropriate treatment though it is second line of agent to this pt.?

a) sumatriptan
b) azathioprine
c) chlorpromazine
d) amitryptilline
e) cyproheptadine
f) lithium
g) selegilline
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Old 10-19-2012
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E. cyproheptadine used for serotonin syndrome inhibitor of 5HT2 receptor
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Old 10-19-2012
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Originally Posted by nishaa View Post
E. cyproheptadine used for serotonin syndrome inhibitor of 5HT2 receptor
you're right...why not sumatriptan used here...?
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Old 10-19-2012
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Sumatriptan is an seratonin agonist . It'll worsen the condition ..
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Old 10-19-2012
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Originally Posted by alice View Post
Sumatriptan is an seratonin agonist . It'll worsen the condition ..
good...the same in the case of amitryptilline and selegilline too..

so here is other
which of the serotonin receptor drugs not require 2nd messenger system for action...?
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Old 10-19-2012
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Correct Answer E is right

the correct answer for 1Q) is E) cyproheptadine

the case presented here is malignant carcinoid syndrome,which is caused by serotonin secreting tumor which usually affects small intestine,appendix--which is called as carcinoid tumor....when the tumor metastasizes to liver it disseminates the whole body symptoms called as serotonin syndrome
most common symptoms---flushing(due to vasodilation),bronchoconstriction(due to histamine release),secretory diarrhea,tricuspid and pulmonary valve fibrosis(carcinoid herat disease)

diagnosis is usuallyy involves detection of serotonin metabolite--5-HIAA in urine..

treatment involves---somatostatin analogue(octreotide) as first line which resolves the symptoms ....serotonin receptor antagonists can be used as second line(like cyproheptadine)..they are seldomly used due to their potential sideeffects...

2Q) sumatriptan is serotonin receptor agonist which is used for migraine.....it rather exacerbates the pt's condition..so it's contraindicated(and also due to cardiac involvement)

3Q) looks like no one answered this one....

it's 5-HT3 receptor drugs like ondansetron,granisetron are not needed 2nd messenger activation...

all the other 6 receptor classes of serotonin requires to be activated by G-protein coupled receptors(except 5-HT3)

Last edited by venky2600; 10-19-2012 at 02:04 PM.
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Old 10-19-2012
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I think sumatriptan is an agonist and cyproheptadine and an antagonist??
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Originally Posted by alice View Post
I think sumatriptan is an agonist and cyproheptadine and an antagonist??
ya thanks....they are misplaced
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