Vanillylmandelic Acid (VMA), Random, Urine
Screening children for catecholamine-secreting tumors
Supporting a diagnosis of neuroblastoma
Monitoring patients with a treated neuroblastoma
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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 1 of the above-mentioned tumors.
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: <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): < or =6.0 mg/g creatinine
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.
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 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 tests are ordered.
Values are more commonly elevated during a hypertensive episode.
Values may be normal in some individuals with a pheochromocytoma.
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, 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 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. Pacak K, Linehan M, Elsenhofer G, et al: Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Internl Med 2001;134(4):315-329
4. 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