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HelpTest ID VH Vanillylmandelic Acid (VMA) and Homovanillic Acid (HVA), Random, Urine
Reporting Name
VMA and HVA, Random, UUseful For
First preferred 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
Specimen Type
UrineAdvisory Information
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 vanillylmandelic acid (VMA) and homovanillic acid (HVA) tests are ordered.
3. Bactrim may interfere with detection of the analyte. All patients taking Bactrim should be identified to the laboratory when VMA and HVA tests are 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 and during collection of specimen.
Supplies: Urine Tubes, 10 mL (T068)
Specimen Volume: 5 mL
Collection Instructions:
1. Collect a random urine specimen.
2. Adjust urine pH to 1 to 5 with 50% acetic or HCl acid.
Specimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| 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
Day(s) and Time(s) Performed
Monday through Friday; 8 a.m.
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 U.S. 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 | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 2143 | Vanillylmandelic Acid, VH | 3124-5 |
| 2144 | Homovanillic Acid, VH | 11146-8 |
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.
Clinical Reference
1. Hyland K, Biaggioni I, Elpeleg ON, et al: Disorders of neurotransmitter metabolism. In Physician's Guide to the Laboratory Diagnosis of Metabolic Disease. Edited by N Blau, M Duran, M E Blaskovics.London UK, Chapman and Hall Medical, 1996, pp 79-98
2. Gitlow SE, Bertani LM, Rausen A, et al: Diagnosis of neuroblastoma by qualitative and quantitative determination of catecholamine metabolites in urine. Cancer 1970;25:1377-1383
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 June;47(9):848-852
Analytic Time
2 days (not reported on Sunday)Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request Form (T729) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/oncology-request-form.pdf)