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Test Code VH Vanillylmandelic Acid (VMA) and Homovanillic Acid (HVA), Random, Urine

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

VMA and HVA, Random, U

Specimen Type

Urine


Advisory 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.


Reject Due To

Hemolysis

NA

Lipemia

NA

Icterus

NA

Other

NA

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated (preferred) 28 days
  Frozen  180 days

Specimen Minimum Volume

2 mL

Day(s) and Time(s) Performed

Monday through Friday; 8 a.m.

Specimen Retention Time

7 days

Analytic Time

2 days (not reported on Sunday)

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

Useful 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

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

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.

Cautions

No significant cautionary statements

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

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, et al: Determination of homovanillic acid in urine by stable isotope dilution and electrospray tandem mass spectrometry. Clin Chim Acta 2001;306:35-41)

 

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 (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 LC-MS/MS 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 MS/MS 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)

Disease States

  • Neuroblastoma

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)