Test ID: VMA Vanillylmandelic Acid, 24 Hour, Urine
Reporting Name
Vanillylmandelic Acid, 24 Hr, UUseful For
Screening children for catecholamine-secreting tumors with a 24-hour urine collection when requesting testing for only vanillylmandelic acid
Supporting a diagnosis of neuroblastoma
Monitoring patients with a treated neuroblastoma
Clinical Information
Vanillylmandelic acid (VMA) and other catecholamine metabolites (homovanillic acid: HVA and dopamine) are typically elevated in patients with catecholamine-secreting tumors (eg, neuroblastoma, pheochromocytoma, and other neural crest tumors). VMA and HVA levels may also be useful in monitoring patients who have been treated as a result of 1 of the above-mentioned tumors.
Interpretation
Vanillylmandelic acid and/or homovanillic acid concentrations are elevated in most patients (more than 90%) 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 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. Hyland K: Disorders of neurotransmitter metabolism. In: Blau N, Duran M, Blaskovics ME, Gibson KM, eds. Physician's Guide to the Laboratory Diagnosis of Metabolic Diseases. Springer; 2003:107-122. doi: 10.1007/978-3-642-55878-8_8
2. Gitlow SE, Bertrani LM, Rausen A, Gribetz D, Dziedzic SW: Diagnosis of neuroblastoma by qualitative and quantitative determination of catecholamine metabolites in urine. Cancer. 1970 Jun;25(6):1377-1383
3. Strenger V, Kerbl R, Dornbusch HJ, et al: Diagnostic and prognostic impact of urinary catecholamines in neuroblastoma patients. Pediatr Blood Cancer. 2007 May;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 Jun;47(9):848-852
5. Matthay KK, Maris JM, Schleiermacher G, et al: Neuroblastoma. Nat Rev Dis Primers. 2016 Nov 10;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. Patients age is required.
2. Collection duration and urine volume are required.
3. All patients receiving L-dopa should be identified to the laboratory when this test is ordered.
4. 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 vanillylmandelic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
Supplies: Urine Tubes, 10 mL (T068)
Specimen Volume: 5 mL
Collection Instructions:
1. Collect a 24-hour urine specimen.
2. Add 25 mL of 50% acetic acid as preservative at the start of collection. If specimen is refrigerated during collection, preservative may be added up to 12 hours after collection. Use 15 mL of 50% acetic acid for children <5 years old. This preservative is intended to achieve a pH of between approximately 1 and 5. If necessary, adjust urine pH to 1 to 5 with 50% acetic or hydrochloric acid.
Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens for multiple collections.
Specimen Minimum Volume
2 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Urine | Refrigerated (preferred) | 28 days | |
Frozen | 180 days |
Special Instructions
Reference Values
<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 (adults): <8.0 mg/24 hours
Test Classification
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
84585
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
VMA | Vanillylmandelic Acid, 24 Hr, U | 43099-1 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
3580 | Vanillylmandelic Acid, Adult (>14y) | 3122-9 |
3581 | Vanillylmandelic Acid, Child (<15y) | 30571-4 |
TM41 | Collection Duration | 13362-9 |
VL39 | Urine Volume | 3167-4 |
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.
mml-Neuro-oncology, mml-Pediatric, mml-Neurometabolic