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Test Directory VMA (Vanillylmandelic Acid), Random Urine

VMA (Vanillylmandelic Acid), Random Urine

Test Summary

Urinary vanillylmandelic acid (VMA) concentration is useful in the biochemical diagnosis and monitoring of neuroblastomas [1]. VMA measurement from random urine specimens, expressed as the ratio of VMA to creatinine, may provide equivalent diagnostic value as VMA measurement from 24-hour urine specimens for the evaluation of neuroblastomas [1].

Neuroblastomas occur predominantly in children and are the most common malignancy 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 HVA 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]. Because poor prognosis is associated with immaturity of catecholamine metabolism, dopamine levels in urine or blood have been proposed as an additional marker to aid in 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 random urine with 6N HCL collected in sterile screw-cap container

Minimum Volume

5 mL

Instructions

10 mL urine: pH adjusted to <3.0 using 6N HCl Urine without preservative is acceptable if pH is below 6 and the sample is shipped frozen.

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

Room temperature

Specimen Stability

Room temperature: 10 days
Refrigerated: 14 days
Frozen: 1 year

Limitations

N/A

Other Acceptable Specimens

N/A

Unacceptable Specimens

pH >3.0 and received frozen

Order Code

VMARU

EPIC (Premier) Code

LAB3271

Includes

Creatinine

CPT Code

82570
84585

Billing Code

670760
670761

CPT Statement

Methodology

High Performance Liquid Chromatography (HPLC) • Electrochemical Detection

FDA Status

This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

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

See Laboratory Report

Setup Schedule / Expected Turnaround Time

Monday - Friday; Report available: 3 - 6 days