Test ID: VH
Vanillylmandelic Acid (VMA) and Homovanillic Acid (HVA), Pediatric, 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
Supporting a diagnosis of neuroblastoma
Monitoring patients with a treated neuroblastoma
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
HVA (Homovanillic Acid)
VMA (Vanillylmandelic Acid)
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.
This collection is performed only on children <15 years of age.
Container/Tube: Plastic, 10-mL urine tube (Supply T068)
Specimen Volume: 10 mL
Collection Instructions:
1. Collect a random urine specimen.
2. Adjust urine pH to 1 to 5 with 50% acetic or HCl acid.
Additional Information:
1. Patient's age is required.
2. Administration of L-dopa may falsely increase homovanillic acid and vanillylmandelic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
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 |
| Frozen | 7 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Elevated values of homovanillic acid (HVA), vanillylmandelic acid (VMA), and other catecholamine metabolites (eg, dopamine) may be suggestive of the presence of a catecholamine-secreting tumor (eg, neuroblastoma, pheochromocytoma, or 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.
VMA
<1 year: <27.0 mg/g creatinine
1 year: <18.0 mg/g creatinine
2-4 years: <13.0 mg/g creatinine
5-9 years: <8.5 mg/g creatinine
10-14 years: <7.0 mg/g creatinine
> or =15 years (adults): not applicable
HVA
<1 year: <35 mg/g creatinine
1 year: <23 mg/g creatinine
2-4 years: <13.5 mg/g creatinine
5-9 years: <9 mg/g creatinine
10-14 years: <12 mg/g creatinine
> or =15 years (adults): not applicable
Interpretation Provides information to assist in interpretation of the test results
Screening children for catecholamine-secreting tumors*
*Positive test could be due to a genetic or non-genetic condition. Additional confirmatory testing is required.
Supporting a diagnosis of neuroblastoma
Monitoring patients with a treated neuroblastoma
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)/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 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/81609 Metanephrines, Fractionated, Free, Plasma
-METAF/83006 Metanephrines, Fractionated, 24 Hour, Urine
-CATU/9276 Catecholamine Fractionation, Free, Urine
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Hyland K, Biaggioni I, Elpeleg ON, et al: Disorders of neurotransmitter metabolism. In Physician's Guide to the Laboratory Diagnosis of Metabolic Disease. Edited by N Blau, M Duran, M E Blaskovics.London UK, Chapman and Hall Medical, 1996, pp 79-98
2. Gitlow SE, Bertani LM, Rausen A, et al: Diagnosis of neuroblastoma by qualitative and quantitative determination of catecholamine metabolites in urine. Cancer 1970;25:1377-1383
3. Strenger V, Kerbl R, Dornbusch HJ, et al: Diagnostic and prognostic impact of urinary catecholamines in neuroblastoma patients. Pediatr Blood Cancer 2007 May;48(5):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-mL aliquot of urine. The solid-phase extraction column is eluted with 1 mL of methanol. The eluate is evaporated at 30 degrees C to 40 degrees C under nitrogen and the residue is reconstituted in 1-mL LC-MS/MS mobile phase. LC-MS/MS is performed by injecting 10 microL of the reconstituted specimen onto an amide-C16 high-pressure liquid chromatography (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 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 a custom-synthesized stable isotope-labeled internal standard ([13]C[6]-4-hydroxy-[18]O-HVA). (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)
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 (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 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 MS/MS 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 stableisotope dilution and electrospray tandem mass spectrometry.Clin Chem 2003;49:825-826)
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-HVA
84585-VMA
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 |
|---|---|---|
| 2143 | Child VMA | 3124-5 |
| 2144 | Child HVA | 11146-8 |
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