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Test Code VMA Vanillylmandelic Acid (VMA), 24 Hour, Urine

Important Note

ASANTE order code: VMAM

Epic/Beaker code is LAB750

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

Vanillylmandelic Acid, 24 Hr, 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. 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 vanillylmandelic acid (VMA) and homovanillic acid (HVA) tests are ordered.

4. 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 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 HCl acid.

Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens in Special Instructions for multiple collections.


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

1 week

Analytic Time

2 days (not reported on Sunday)

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

Useful 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

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

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

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.

Cautions

Values are more commonly elevated during a hypertensive episode.

 

Values may be normal in some individuals with pheochromocytoma.

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 Diseases. Edited by N Blau, M Duran, ME Blaskovics. London, UK, Chapman and Hall Medical, 1996, pp 79-98

2. Gitlow SE, Bertrani LM, Rausen A, et al: Diagnosis of neuroblastoma by qualitative and quantitative determination of catecholamine metabolites in urine. Cancer 1970;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;48:504-509

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

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 (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 mass spectrometry/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)

Urine Preservative Collection Options

Ambient

No

Refrigerated

No

Frozen

No

6N HCl

Yes

50% Acetic Acid

Preferred

Na2CO3

No

Toluene

No

6N HNO3

Yes

Boric Acid

Yes* (pH must be <5)

Thymol

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.

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)