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Test Directory VMA (Vanillylmandelic Acid), 24-Hour Urine with Creatinine

VMA (Vanillylmandelic Acid), 24-Hour Urine with Creatinine

Test Summary

Urinary vanillylmandelic acid (VMA) concentration is useful in the biochemical diagnosis and monitoring of neuroblastomas [1].

Neuroblastomas occur predominantly in children and are the most common malignancy in those under 1 year old. Neuroblastomas are catecholamine-metabolizing tumors with limited ability to store and secrete catecholamines. Thus, catecholamine metabolites-including VMA and homovanillic acid (HVA)-are more reliable than catecholamines as biochemical markers for neuroblastomas [1]. VMA and HVA levels, usually measured simultaneously, can be elevated in neuroblastomas as well as other catecholamine-secreting tumors, such as pheochromocytoma [1]. In patients with familial dysautonomia (Riley-Day syndrome), a neurological disorder found mainly in individuals of Ashkenazi Jewish descent, VMA levels are generally elevated while HAV levels may be normal or decreased [2].

Urinary VMA and HVA levels may have limited accuracy for diagnosis of neuroblastomas with high-risk metastatic biology [1]. Therefore, dopamine levels in urine or serum have been proposed as an additional marker for diagnosis and monitoring of neuroblastomas [3].

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Eisenhofer G. Monoamine-producing tumors. In: Rifai R, et al. eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier Inc; 2022.
2. Axelrod FB. Familial dysautonomia. Muscle Nerve. 2004;29(3):352-363.
3. Brodeur GM, et al. J Clin Oncol. 1993;11(8):1466-1477.

Aliases

Specimen Collection

Special Instructions

N/A

Preferred Specimen

10 mL aliquot from a 24-hour urine that has been preserved with 25 mL 6N HCl, collected in a plastic 24-hour urine container

Minimum Volume

5 mL

Instructions

Collect 24-hour urine with 25 mL 6N HCl to maintain a pH ≤3. If no preservative is used, specimen must be stored refrigerated during collection but shipped frozen and pH must be ≤6.
Record 24-hour urine volume and patient's age on test request form and on urine container.

Patient Preparation

It is preferable for the patient to be off medications for three days prior to collection. However, common antihypertensives (diuretics, ACE inhibitors, calcium channel blockers, alpha and beta blockers) cause minimal or no interference. Patient should avoid alcohol, coffee, tea, tobacco (including use of nicotine patch), bananas, citrus fruits and strenuous exercise prior to collection.

Storage

N/A

Transport Temperature

Preserved urine: Room temperature
Unpreserved urine: Frozen

Specimen Stability

Preserved urine
Room temperature: 10 days
Refrigerated: 14 days
Frozen: 1 year
Unpreserved urine
Room temperature: Unacceptable
Refrigerated: Unacceptable
Frozen: 30 days

Limitations

N/A

Other Acceptable Specimens

10 mL aliquot from 24-hour urine, unpreserved, with pH ≤ 6, collected in plastic 24-hour urine container

Unacceptable Specimens

Preserved urine received refrigerated with pH >3 • Unpreserved urine received frozen with pH >6

Order Code

VMA24

EPIC (Premier) Code

LAB3953

Includes

CPT code 81050 may be added at an additional charge for volume measurement

CPT Code

82570
84585

Billing Code

670758
670759
500002

CPT Statement

Methodology

High Performance Liquid Chromatography (HPLC)

FDA Status

FDA Approved

Physician Attestation of Informed Consent

N/A

Testing Laboratory

Quest Diagnostics Nichols Institute
33608 Ortega Highway
San Juan Capistrano CA, 92675

Department

Reference Testing

Reference Range

VMA, 24-Hour Urine

<3 Years			Not established
3-8 Years			≤2.3 mg/24 hours
9-12 Years			≤3.4 mg/24 hours
13-17 Years			≤3.9 mg/24 hours
Adults			≤6.0 mg/24 hours

Creatinine, 24-Hour Urine

<3 Years			Not established
3-8 Years			0.10-0.80 g/24 h
9-12 Years			0.20-1.40 g/24 h
13-17 Years			0.40-1.90 g/24 h
>17 Years			0.50-2.15 g/24 h

Setup Schedule / Expected Turnaround Time

Monday - Saturday; Report available: 3 - 4 days