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26142 Vanillylmandelic Acid (VMA), Random Urine (VMAR)

Vanillylmandelic Acid (VMA), Random Urine (VMAR)
Test Code: VMARSO
Synonyms/Keywords
​3-Methoxy-4-Hydroxymandelic Acid
4-Hydroxy-3-Methoxymandelic Acid
Neuroblastoma Profile
Vanillylmandelic Acid
VMA
Useful For
Screening children for catecholamine-secreting tumors with a random urine collection when requesting vanillylmandelic acid only 
 
Supporting a diagnosis of neuroblastoma 
 
Monitoring patients with a treated neuroblastoma
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No ​Urine ​Urine Plastic Container ​ ​5 mL ​4 mL ​2 mL
Collection Processing Instructions
​NOTE:
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 (HVA) tests are ordered.
  
Bactrim may interfere with detection of the analyte. All patients taking Bactrim should be identified to the laboratory when VMA and HVA tests are ordered.
 
Collection Instructions:
1. Collect a random urine specimen.
2. pH adjustment not necessary if specimen will arrive at testing lab (Mayo Medical Laboratories) within 6 days of collection.
3. If specimen will not arrive at testing lab within 6 days from collection, adjust the random urine pH to a level between 1 and 5 by adding 50% acetic acid dropwise and checking the (Special Chemistry department staff will adjust pH prior to sending to Mayo)
pH. (Special Chemistry department staff will adjust pH prior to sending to Mayo)
Additional Information:
1. Patient's age is required.
2. Administration of L-dopa may falsely increase vanillylmandelic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
Specimen Stability Information
Specimen Type Temperature Time
​Urine ​ ​Refrigerate (preferred) ​28 days
​Frozen ​180 days
Interference
​Administration of L-dopa may falsely increase vanillylmandelic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday through Friday, 8am ​2 days ​SPE methodology;  Analysis by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reference Lab
Mayo Clinic Laboratories
Test Information
This test was developed and its performance characteristics determined by Mayo Clinic Laboratories.
​
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 one of the above-mentioned tumors. 
More than 90% of individuals with neuroblastoma have elevated VMA or HVA.
VMA is not the analyte of choice for diagnosis of pheochromocytoma, which is better detected by testing for metanephrines.
Treatment with L-dopa can impact test results and should be discontinued 24 hours prior to collection. Bactrim can impact test results and should be noted at time of collection.
Reference Range Information
Performing Location Reference Range
​Mayo Clinic Laboratories ​<1 year: <25.0 mg/g creatinine
1 year: <22.5 mg/g creatinine
2-4 years: <16.0 mg/g creatinine
5-9 years: <12.0 mg/g creatinine
10-14 years: <8.0 mg/g creatinine
> or =15 years (adults): <7.0 mg/g creatinine
Interpretation
​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.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​84585 ​ ​1 ​ ​
Classification
This test was developed and its performance characteristics determined by Mayo Clinic Laboratories.
Synonyms/Keywords
​3-Methoxy-4-Hydroxymandelic Acid
4-Hydroxy-3-Methoxymandelic Acid
Neuroblastoma Profile
Vanillylmandelic Acid
VMA
Ordering Applications
Ordering Application Description
​Centricity ​Vanillylmandelic Acid (VMA), Random Urine (VMAR)
​Cerner ​Vanillylmandelic Acid (VMA), Random Urine (VMAR)
​COM ​Vanillylmandelic Acid (VMA), Random Urine (VMAR)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No ​Urine ​Urine Plastic Container ​ ​5 mL ​4 mL ​2 mL
Collection Processing
​NOTE:
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 (HVA) tests are ordered.
  
Bactrim may interfere with detection of the analyte. All patients taking Bactrim should be identified to the laboratory when VMA and HVA tests are ordered.
 
Collection Instructions:
1. Collect a random urine specimen.
2. pH adjustment not necessary if specimen will arrive at testing lab (Mayo Medical Laboratories) within 6 days of collection.
3. If specimen will not arrive at testing lab within 6 days from collection, adjust the random urine pH to a level between 1 and 5 by adding 50% acetic acid dropwise and checking the (Special Chemistry department staff will adjust pH prior to sending to Mayo)
pH. (Special Chemistry department staff will adjust pH prior to sending to Mayo)
Additional Information:
1. Patient's age is required.
2. Administration of L-dopa may falsely increase vanillylmandelic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
Specimen Stability Information
Specimen Type Temperature Time
​Urine ​ ​Refrigerate (preferred) ​28 days
​Frozen ​180 days
Interference
​Administration of L-dopa may falsely increase vanillylmandelic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
Useful For
Screening children for catecholamine-secreting tumors with a random urine collection when requesting vanillylmandelic acid only 
 
Supporting a diagnosis of neuroblastoma 
 
Monitoring patients with a treated neuroblastoma
Reference Range Information
Performing Location Reference Range
​Mayo Clinic Laboratories ​<1 year: <25.0 mg/g creatinine
1 year: <22.5 mg/g creatinine
2-4 years: <16.0 mg/g creatinine
5-9 years: <12.0 mg/g creatinine
10-14 years: <8.0 mg/g creatinine
> or =15 years (adults): <7.0 mg/g creatinine
Interpretation
​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.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday through Friday, 8am ​2 days ​SPE methodology;  Analysis by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​84585 ​ ​1 ​ ​
Classification
This test was developed and its performance characteristics determined by Mayo Clinic Laboratories.
For most current information refer to the Marshfield Laboratory online reference manual.