VMA (Vanillylmandelic Acid), Random Urine

Test Code

1710

CPT Codes
82570, 84585

Includes

Creatinine

Preferred Specimen

10 mL random urine with 6N HCL collected in sterile screw-cap 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

Instructions

10 mL urine: pH adjusted to <3.0 using 6N HCl Urine without preservative is acceptable if pH is below 6 and the sample is shipped frozen.

Transport Temperature

Room temperature

Specimen Stability

Room temperature: 10 days
Refrigerated: 14 days
Frozen: 1 year

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

pH >3.0 and received frozen

Methodology
High Performance Liquid Chromatography (HPLC) • Electrochemical Detection

FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Setup Schedule

Set up: Mon-Fri; Report available: 3-6 days

Reference Range

See Laboratory Report

Clinical Significance

Urinary vanillylmandelic acid (VMA) concentration is useful in the biochemical diagnosis and monitoring of neuroblastomas [1]. VMA measurement from random urine specimens, expressed as the ratio of VMA to creatinine, may provide equivalent diagnostic value as VMA measurement from 24-hour urine specimens for the evaluation of neuroblastomas [1].

Neuroblastomas occur predominantly in children and are the most common malignancy 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 HVA 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]. Because poor prognosis is associated with immaturity of catecholamine metabolism, dopamine levels in urine or blood have been proposed as an additional marker to aid in 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

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.