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

Message

For Specimen Integrity during Extreme Weather see the “Lockbox Usage in Extreme Weather” document at the top of this page.

Test Code

VMA24

CPT Codes
82570, 84585

Includes

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

Preferred Specimen

10 mL aliquot from a 24-hour urine that has been preserved with 25 mL 6N HCl, collected in a plastic 24-hour 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

Set up: Mon-Sat; Report available: 3-4 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 Inst San Juan Capistrano
33608 Ortega Highway
San Juan Capistrano, CA 92690-6130

Last Updated: December 7, 2021

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.