Test Id : VMA
Vanillylmandelic Acid, 24 Hour, Urine
Useful For
Suggests clinical disorders or settings where the test may be helpful
Screening children for catecholamine-secreting tumors using a 24-hour urine collection when requesting testing for vanillylmandelic acid only
Supporting a diagnosis of neuroblastoma
Monitoring patients with a treated neuroblastoma
Highlights
Vanillylmandelic acid (VMA) and other catecholamine metabolite, such as homovanillic acid (HVA), measurements in urine are used for screening children for catecholamine-secreting tumors, such as neuroblastoma and other neural crest tumors, and monitoring those who have had treatment for these tumors.
More than 90% of individuals with neuroblastoma have elevated VMA and/or HVA.
VMA is not the analyte of choice for diagnosis of pheochromocytoma, which is better detected by testing for metanephrines.
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.
Method Name
A short description of the method used to perform the test
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Vanillylmandelic Acid
3-Methoxy-4-Hydroxymandelic Acid
4-Hydroxy-3-Methoxymandelic Acid
VMA
Neuroblastoma Profile
Specimen Type
Describes the specimen type validated for testing
Urine
Ordering 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. Collection duration (in hours) and urine volume (in milliliters) 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.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| TM41 | Collection Duration | |
| VL39 | Urine Volume |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Patient Preparation: Administration of L-dopa may falsely increase vanillylmandelic acid results. For 24 hours prior to specimen collection, the patient should not take L-dopa.
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. Add 25 mL of 50% acetic acid as preservative at the start of collection. Use 15 mL of 50% acetic acid for children younger than 5 years. If specimen is refrigerated during collection, preservative may be added up to 12 hours after collection. 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: For multiple collections see Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.
Urine Preservative Collection Options
Note: For addition of preservative or application of temperature information, see Specimen Required.
| Ambient (no additive) | No |
| Refrigerate (no additive) | No |
| Frozen (no additive) | No |
| 50% Acetic Acid | Preferred |
| Boric Acid* | OK |
| Diazolidinyl Urea | No |
| 6M Hydrochloric Acid | OK |
| 6M Nitric Acid | OK |
| Sodium Carbonate | No |
| Toluene | No |
| *If boric acid is used, note on specimen container. Also, verify that pH is in desired range (pH=1-5). If pH is outside of desired range, adjust pH with a stronger acid (acetic acid is preferred but other acids listed above could be used if available) in a dropwise fashion to bring pH into desired range. | |
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
2 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 28 days | |
| Frozen | 180 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Screening children for catecholamine-secreting tumors using a 24-hour urine collection when requesting testing for vanillylmandelic acid only
Supporting a diagnosis of neuroblastoma
Monitoring patients with a treated neuroblastoma
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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 one of the above-mentioned tumors.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
<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
> or =15 years (adults): <8.0 mg/24 hours
Interpretation
Provides information to assist in interpretation of the test results
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.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Values are more commonly elevated during a hypertensive episode.
Values may be normal in some individuals with pheochromocytoma.
All patients taking Bactrim should be identified to the laboratory when vanillylmandelic acid and homovanillic acid tests are ordered due to potential interference.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
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: 765-765.e54
2. 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
3. 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
4. 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
5. 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
6. Matthay KK, Maris JM, Schleiermacher G, et al. Neuroblastoma. Nat Rev Dis Primers. 2016;2:16078. doi:10.1038/nrdp.2016.78
Method Description
Describes how the test is performed and provides a method-specific reference
Vanillylmandelic acid (VMA) is measured by solid-phase extraction (SPE) of a 1-mL aliquot of urine. A known amount of stable-isotope labeled VMA internal standard (IS) is added to each urine specimen prior to SPE. VMA and IS are eluted from the SPE column with methanol. The methanol is evaporated and the VMA and IS are redissolved in liquid chromatography tandem mass spectrometry mobile phase. A portion of this prepared extract is injected onto a LC column that separates VMA and IS from the bulk of any remaining specimen matrix. The VMA and IS are measured by tandem-mass spectrometry using the selected reaction monitoring mode. VMA is quantified using the ratio to IS versus urine calibrators.(Magera MJ, Thompson AL, Stoor AL, et al. Determination of vanillylmandelic acid in urine by stable isotope dilution and electrospray tandem mass spectrometry. Clin Chem. 2003;49:825-826; 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)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
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Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
84585
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| VMA | Vanillylmandelic Acid, 24 Hr, U | 43099-1 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 3580 | Vanillylmandelic Acid, Adult (>14y) | 3122-9 |
| 3581 | Vanillylmandelic Acid, Child (<15y) | 30571-4 |
| TM41 | Collection Duration | 13362-9 |
| VL39 | Urine Volume | 3167-4 |