Serotonin is metabolized by monoamine oxidase, and the intermediate product, 5- hydroxyindoleacetaldehyde, is further oxidized by aldehyde dehydrogenase to 5- hydroxyindoleacetic acid (5-HIAA). In humans consuming a normal diet, the excretion of 5-HIAA, is a measure of serotonin synthesis. Therefore, the 24-hour excretion of 5S-HIAA can be used as a diagnostic test for tumors that synthesize excessive quantities of serotonin, especially carcinoid tumor. A few foods (eg, bananas) contain large amounts of serotonin or its precursors and must be prohibited during such diagnostic tests. Pharmacodynamics Mechanisms of Action Serotonin exerts many actions and, like histamine, has many species differences, making generalizations difficult, The actions of serotonin are mediated through a remarkably large number of cell membrane receptors. The serotonin receptors that have been characterized thus far are described in Table 16-3. Seven families of 5-HT-receptor subtypes (those given numeric subscripts 1 through 7) have been identified, six involving G protein-coupled receptors and one a ligand-gated ion channel, Among these receptor subtypes, several lack any recognized physiologic function. Discovery of these functions awaits the development of subtype-selective drugs or the mutation or deletion of genes encoding these receptors from the mouse genome. Table 16-3. Serotonin Receptor Subtypes. Receptor. Postreeeptor Subtype Mechan age ts Raphe nuclei, 8-OH-DPAT WAY 100635 hippocampus /Substantia nigra, 4cAMP P93129 globus pallidus, basal ganglia es = = HT — |Cortex, ucAMP. hippocampus system. Platelets, smooth |G, , +IP a-Methyl-5-HT Ketanserin muscle, cerebral cortex, skeletal muscle