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HelpTest ID: VH Vanillylmandelic Acid and Homovanillic Acid, Random, Urine
Reporting Name
VMA and HVA, Random, UUseful For
Preferred first test for screening for catecholamine-secreting tumors in a random urine specimen when requesting both homovanillic acid and vanillylmandelic acid
Supporting a diagnosis of neuroblastoma
Monitoring patients with a treated neuroblastoma
Clinical Information
Elevated values of homovanillic acid (HVA), vanillylmandelic acid (VMA), and other catecholamine metabolites (eg, dopamine) may be suggestive of the presence of a catecholamine-secreting tumor (eg, neuroblastoma, pheochromocytoma, or other neural crest tumors). HVA and VMA levels may also be useful in monitoring patients who have been treated as a result of the above-mentioned tumors. HVA levels may also be altered in disorders of catecholamine metabolism: monamine oxidase-A deficiency can cause decreased urinary HVA values, while a deficiency of dopamine beta-hydrolase (the enzyme that converts dopamine to norepinephrine) can cause elevated urinary HVA values.
Interpretation
Homovanillic acid (HVA) and vanillylmandelic acid (VMA) concentrations are elevated in more than 90% of patients with neuroblastoma; both tests should be performed. A positive test could be due to a genetic or nongenetic condition. Additional confirmatory testing is required.
A normal result does not exclude the presence of a catecholamine-secreting tumor.
Elevated HVA and VMA values are suggestive of a pheochromocytoma, but they are not diagnostic.
Report Available
3 to 5 daysDay(s) Performed
Monday through Friday
Clinical Reference
1. Eisenhofer G: Monoamine-producing tumors. In: Rifai N, Chiu RWK, Young I, Burnham CD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:765
2. Ormazabal A, Molero-Luis M, Garcia-Cazorla A, Artuch R. Biomarkers for the study of catecholamine and serotonin genetic diseases. In: Garg U, Smith LD, eds. Biomarkers in Inborn Errors of Metabolism: Clinical Aspects and Laboratory Determination. Elsevier; 2017:301-329
3. Strenger V, Kerbl R, Dornbusch HJ, et al. Diagnostic and prognostic impact of urinary catecholamines in neuroblastoma patients. Pediatr Blood Cancer. 2007;48(5):504-509
4. Barco S, Gennai I, Reggiardo G, et al. Urinary homovanillic and vanillylmandelic acid in the diagnosis of neuroblastoma: report from the Italian Cooperative Group for Neuroblastoma. Clin Biochem. 2014;47(9):848-852
5. Matthay KK, Maris JM, Schleiermacher G, et al. Neuroblastoma. Nat Rev Dis Primers. 2016;2:16078. doi:10.1038/nrdp.2016.78
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Specimen Type
UrineOrdering Guidance
In the past, this test has been used to screen for pheochromocytoma. However, vanillylmandelic acid (VMA) is not the analyte of choice to rule out a diagnosis of pheochromocytoma. Recommended tests for that purpose include:
-PMET / Metanephrines, Fractionated, Free, Plasma
-METAF / Metanephrines, Fractionated, 24 Hour, Urine
-CATU / Catecholamine Fractionation, Free, 24 Hour, Urine
Necessary Information
1. Patient's age is required.
2. All patients receiving L-dopa should be identified to the laboratory when this test is ordered.
3. Bactrim may interfere with detection of the analyte. All patients taking Bactrim should be identified to the laboratory when this test is ordered.
Specimen Required
Patient Preparation: Administration of L-dopa may falsely increase homovanillic acid and vanillylmandelic acid results; it should be discontinued 24 hours prior to specimen collection.
Supplies: Urine Tubes, 10 mL (T068)
Collection Container/Tube: Clean, plastic urine collection container
Submission Container/Tube: Plastic, 10-mL urine tube
Specimen Volume: 5 mL
Collection Instructions:
1. Collect a random urine specimen.
2. Adjust the urine pH to a level between 1 and 5 by adding 50% acetic acid or hydrochloric acid dropwise and checking the pH.
Specimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 28 days | |
| Frozen | 180 days |
Reference Values
VANILLYLMANDELIC ACID
<1 year: <25.0 mg/g creatinine
1 year: <22.5 mg/g creatinine
2-4 years: <16.0 mg/g creatinine
5-9 years: <12.0 mg/g creatinine
10-14 years: <8.0 mg/g creatinine
≥15 years: <7.0 mg/g creatinine
HOMOVANILIC ACID
<1 year: <35.0 mg/g creatinine
1 year: <30.0 mg/g creatinine
2-4 years: <25.0 mg/g creatinine
5-9 years: <15.0 mg/g creatinine
10-14 years: <9.0 mg/g creatinine
≥15 years: <8.0 mg/g creatinine
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
83150-HVA
84585-VMA
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| VH | VMA and HVA, Random, U | 90250-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 2143 | Vanillylmandelic Acid, VH | 3124-5 |
| 2144 | Homovanillic Acid, VH | 11146-8 |
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.
mml-Neuro-oncology, mml-Pediatric, mml-Neurometabolic