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HelpTest ID HVA Homovanillic Acid, 24 Hour, Urine
Reporting Name
Homovanillic Acid (HVA), 24 Hr, UUseful For
Screening children for catecholamine-secreting tumors using a 24-hour urine collection when requesting homovanillic acid only
Monitoring neuroblastoma treatment
Screening patients with possible inborn errors of catecholamine metabolism
Specimen Type
UrineNecessary Information
1. Collection duration and urine volume in milliliters are required.
2. Patient's age is 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 homovanillic acid results; it should be discontinued 24 hours prior to and during specimen collection.
Supplies: Urine Tubes, 10 mL (T068)
Container/Tube: Plastic, 10-mL urine tube
Specimen Volume: 5 mL
Collection Instructions:
1. Add 25 mL of 50% acetic acid as preservative at 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 younger than 5 years. This preservative is intended to achieve a pH of between approximately 1 and 5.
2. Collect a 24-hour urine specimen.
3. If necessary, adjust urine pH to a level between 1 and 5 by adding 50% acetic acid or hydrochloric acid dropwise and checking the pH.
Additional Information:
1. The sensitivity of this test is greater on a 24-hour specimen than on a random specimen.
2. 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 |
Reference Values
<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 (adults): <8.0 mg/24 hours
Day(s) Performed
Monday through Friday
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
Interpretation
Vanillylmandelic acid (VMA) and/or homovanillic acid (HVA) concentrations are elevated in over 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 values are suggestive of a deficiency of dopamine beta-hydrolase, a neuroblastoma, a pheochromocytoma, or may reflect administration of L-dopa.
Decreased urinary HVA values may suggest monoamine oxidase-A deficiency.
Cautions
Administration of L-dopa may falsely increase homovanillic acid (HVA) results. Patients receiving L-dopa should stop taking it for 24 hours before and during the collection.
All patients receiving L-dopa should be identified to the laboratory when vanillylmandelic acid (VMA) and HVA tests are ordered.
All patients taking Bactrim should be identified to the laboratory when VMA and HVA tests are ordered due to potential interference.
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 Description
Homovanillic acid (HVA) is measured by solid-phase extraction (SPE) of a 1-mL aliquot of urine. A known amount of stable-isotope labeled HVA internal standard (IS) is added to each urine specimen prior to SPE. HVA and IS are eluted from the SPE column with methanol. The methanol is evaporated, and the HVA and IS are redissolved in liquid chromatography tandem-mass spectrometry (LC-MS/MS) mobile phase. A portion of this prepared extract is injected onto a LC column that separates HVA and IS from the bulk of any remaining specimen matrix. The HVA and IS are measured by mass spectrometry/tandem-mass spectrometry using the selected reaction monitoring mode. HVA is quantified using the ratio to IS versus urine calibrators.(Magera MJ, Stoor A, Helgeson JK, Matern D, Rinaldo P. Determination of homovanillic acid in urine by stable isotope dilution and electrospray tandem mass spectrometry. Clin Chim Acta. 2001;306[1-2]:35-41; Eisenhofer G, Grebe S, Cheung NV. Monoamine-producing tumors. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:chap 63)
Report Available
2 to 4 daysReject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.NY State Approved
YesMethod Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Highlights
Homovanillic acid (HVA) measurement in urine is used for screening children for catecholamine-secreting tumors, such as neuroblastoma, pheochromocytoma, and other neural crest tumors, and monitoring those who have had treatment for these tumors.
HVA measurement is also useful for diagnosing children with disorders of catecholamine metabolism, such as monoamine oxidase-A deficiency and dopamine beta-hydroxylase deficiency, which result in either decreased or elevated urinary HVA values, respectively.
Treatment with L-dopa can impact test results and should be discontinued 24 hours prior to collection. Bactrim can impact test results and should be noted at time of collection.
Disease States
- Neuroblastoma
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.