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

Test Code

VAC24

CPT Codes
82570, 84585   CPT code 81050 may be added at an additional charge for volume measurement.

Includes

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

Preferred Specimen

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.

Specimen
Type: Preserved Urine

Collection
Container/Type

Preferred: 24-Hour urine collection
containing 25 mL 6N HCl

Acceptable: 24-Hour urine collection, no
preservative

Submission
Container/Tube: Plastic vial

Specimen
Volume: 10 mL

Collection
Instructions:

Collect 24-hour urine
with 25 mL 6N HCl to maintain 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 patients 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.

Minimum Volume

5 mL

Other Acceptable Specimens

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

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.

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

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

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

Methodology

High Performance Liquid Chromatography (HPLC)

Setup Schedule

Monday - Friday

Report Available

2 days

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

Clinical Significance

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.

Performing Laboratory
Quest Diagnostics Nichols Institute 14225 Newbrook Drive Chantilly, VA 20153

Last Updated: February 17, 2023

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.