Test ID: HVA
Homovanillic Acid (HVA), 24 Hour, Urine
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Screening children for catecholamine-secreting tumors
Monitoring neuroblastoma treatment
Screening patients with possible inborn errors of catecholamine metabolism
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Neuroblastoma Profile
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Plastic, 10-mL urine tube (Supply T068)
Specimen Volume: 6 mL
Collection Instructions:
1. Collect a 24-hour urine specimen.
2. Add 25 mL of 50% acetic acid as preservative at start of collection. Use 15 mL of 50% acetic acid for children <5 years old.
3. 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 HCI acid.
Additional Information:
1. Patient's age and 24-hour volume are required.
2. Administration of L-dopa may falsely increase homovanillic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
3. The sensitivity of this test is greater on a 24-hour specimen than on a random specimen.
4. See Urine Preservatives in Special Instructions for multiple collections.
5. Bactrim may interfere with detection of the analyte. All patients taking Bactrim should be identified to the laboratory when this test is ordered.
Urine Preservative Collection Options
| Ambient | No |
| Refrigerated | No |
| Frozen | No |
| 6N HCl | Yes |
| 50% Acetic Acid | Preferred |
| Na2CO3 | No |
| Toluene | No |
| 6N HNO3 | No |
| Boric Acid | No |
| Thymol | No |
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 7 days |
| Ambient | 7 days | |
| Frozen | 7 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Homovanillic acid (HVA) and other catecholamine metabolites (vanillylmandelic acid [VMA] and dopamine) are typically elevated in patients with catecholamine-secreting tumors (eg, neuroblastoma, pheochromocytoma, and 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.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
<1 year: <35.0 mg/g creatinine
1 year: <23.0 mg/g creatinine
2-4 years: <13.5 mg/g creatinine
5-9 years: <9.0 mg/g creatinine
10-14 years: <12.0 mg/g creatinine
> or =15 years (adults): <8 mg/24 hours
Interpretation Provides information to assist in interpretation of the test results
Vanillylmandelic acid (VMA) and/or homovanillic acid (HVA) concentrations are elevated in over 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 values are suggestive of a deficiency of dopamine beta-hydrolase, a neuroblastoma, a pheochromocytoma, or may reflect administration of L-dopa.
Decreased urinary HVA values may suggest monamine oxidase-A deficiency.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Administration of L-dopa may falsely increase homovanillic acid (HVA) 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 vanillylmandelic acid (VMA) and HVA tests are ordered.
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.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Hyland K, Biaggioni I, Elpeleg OH, et al: Disorders of neurotransmitter metabolism. In Physician's Guide to the Laboratory Diagnosis of Metabolic Disease, Chapman and Hall Medical. Edited by N Blau, M Duran, ME Blaskovics. London, UK. 1996, pp 79-98
2. Hyland K: Presentation, diagnosis, and treatment of the disorders of monoamine neurotransmitter metabolism. Sem Perinatol 1999;23:194-203
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
Method Description Describes how the test is performed and provides a method-specific reference
Homovanillic acid (HVA) is measured in urine by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Octadecyl (C18) solid-phase extraction is performed on a 1.2-mL aliquot of urine from a 24-hour collection. The solid-phase extraction column is eluted with 1.0-mL methanol. The eluate is evaporated at 30 to 40 degrees C under nitrogen, and the residue is reconstituted in 1.0 mL LC-MS/MS mobile phase. LC-MS/MS is performed by injecting 10 microL of the reconstituted specimen onto an amide-C16 HPLC column. The mobile phase (30% acetonitrile in 0.05% aqueous acetic acid) is pumped over the HPLC analytical column at the rate of 1.0 mL/min, with the flow diverted to the MS/MS electrospray probe tip by 1:5. HVA elutes apart from the bulk of the specimen matrix at a retention time of approximately 1.5 minutes. HVA is quantitated by using custom-synthesized stable isotope-labeled internal standard ([13]C[6]-4-hydroxy-[18]O-HVA) from calibration over a concentration range of 1.04 to 16.7 mg/L. (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)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Saturday; 8 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
83150
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 3572 | HVA, Adult | 2436-4 |
| 3573 | HVA, Child (<15 yr) | 13760-4 |
| TM39 | Collection Duration | 13362-9 |
| VL37 | Urine Volume | 3167-4 |
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