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Test Code VMAR Vanillylmandelic Acid (VMA), Random, Urine

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

Vanillylmandelic Acid, Random, U

Specimen Type


Specimen Required

Container/Tube: Plastic, 10-mL urine tube (T068)

Specimen Volume: 5 mL

Collection Instructions:

1. Collect a random urine specimen.

2. Adjust the random urine pH to a level between 1 and 5 by adding 50% acetic acid dropwise and checking the pH.

Additional Information:

1. Patient's age is required.

2. Administration of L-dopa may falsely increase vanillylmandelic acid results; it should be discontinued 24 hours prior to and during collection of specimen.

Reject Due To









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 Sundays)

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): <7.0 mg/g creatinine

Useful For

Screening children for catecholamine-secreting tumors with a random urine collection when requesting vanillylmandelic acid only


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


LOINC Code Information

Test ID Test Order Name Order LOINC Value
VMAR Vanillylmandelic Acid, Random, U 3124-5


Result ID Test Result Name Result LOINC Value
60274 Vanillylmandelic Acid, Random, U 3124-5

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 one of the above-mentioned tumors.


Vanillylmandelic acid (VMA) and/or homovanillic acid 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 VMA values are suggestive of a pheochromocytoma, but they are not diagnostic.


Administration of L-dopa may falsely increase vanillylmandelic acid (VMA) 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 VMA and homovanillic acid (HVA) tests are ordered.


Values are more commonly elevated during a hypertensive episode.


Values may be normal in some individuals with a pheochromocytoma.


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.


In the past, this test has been used to screen for pheochromocytoma. However, VMA is not the analyte of choice to rule out a diagnosis of pheochromocytoma. Recommended tests for this purpose are:

-PMET / Metanephrines, Fractionated, Free, Plasma

-METAF / Metanephrines, Fractionated, 24 Hour, Urine

-CATU / Catecholamine Fractionation, Free, 24 Hour, Urine

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(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

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)

Disease States

  • Neuroblastoma