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Overview Test Methodology Liquid Chromatography - Tandem Mass Spectrometry (LC-MS/MS) Test Usage Evaluate catecholamine production, useful in the diagnosis of pheochromocytoma and neuroblastoma and in confirmation of elevated catecholamine levels. Reference Range * 24 Hour Urine - VMA: Random Urine - VMA / Creatinine Ratio: Test Limitations False elevations may occur if patients do not follow the VMA preparation instructions. Days Set Up Monday, Thursday MiChart Code VMA, 24HR Urine Synonyms Laboratory Chemical Pathology Specimen RequirementsCollection Instructions Collect 24 hour urine specimen. Add 25 mL of 50% glacial acetic acid (15 mL for pediatric patients) to container prior to start of collection. Following collection, mix well, measure 24 hour urine volume, aliquot 10 mL into a plastic urine container and refrigerate. Record total 24 hour urine volume and collection dates/times on request form. Specimens with no preservative are also acceptable: add 50% glacial acetic acid to container following collection, mix well and send 10 mL aliquot (preferred); alternatively a non-acidified aliquot will be accepted. Patient should avoid medications, chocolate, fruit, bananas and any vanilla containing substances for 48 hrs prior to beginning collection. Random samples will be accepted on children less than 10 years old, in which case the VMAR test code must be ordered instead of the VMA test code. Alternate Specimen May be collected in plain (no preservative) container and acid added at the end of collection. It is preferred to
have acid added as soon as possible at the client site, mixed, and an aliquot sent. A non-acidified aliquot may also be sent. [rev 9/08] Random samples will be accepted on children less than 10 years old, in which case the VMAR test code must be ordered instead of the VMA test code. Contraindications Patient should avoid medications, chocolate, fruit, bananas and any vanilla containing substances for 48 hrs prior to and during collection. Normal Volume 10 mL aliquot of 24 hour urine collection, 6 mL of a random collection. Minimum Volume 4 mL aliquot of 24 hour urine collection, 4 mL of a random collection. Billing© 2021 Laboratory Corporation of America® Holdings and Lexi-Comp Inc. All Rights Reserved. CPT Statement/Profile Statement The LOINC® codes are copyright © 1994-2021, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf Useful For Suggests clinical disorders or settings where the test may be helpful Screening children for catecholamine-secreting tumors with a 24-hour urine collection when requesting testing for only vanillylmandelic acid Supporting a diagnosis of neuroblastoma Monitoring patients with a treated neuroblastoma Highlights Vanillylmandelic acid (VMA) and other catecholamine metabolites such as homovanillic acid (HVA) measurement in urine are used for screening children for catecholamine-secreting tumors such as neuroblastoma and other neural crest tumors and monitoring those who have had treatment for these tumors. More than 90% of individuals with neuroblastoma have elevated VMA and/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. Special Instructions Library of PDFs including pertinent information and forms related to the test
Method Name A short description of the method used to perform the test Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) NY State Available Indicates the status of NY State approval and if the test is orderable for NY State clients. Yes Reporting Name Lists a shorter or abbreviated version of the Published Name for a test Vanillylmandelic Acid, 24 Hr, U Aliases Lists additional common names for a test, as an aid in searching Vanillylmandelic Acid 3-Methoxy-4-Hydroxymandelic Acid 4-Hydroxy-3-Methoxymandelic Acid VMA Neuroblastoma Profile Specimen Type Describes the specimen type validated for testing Urine Ordering Guidance In the past, this test has been used to screen for pheochromocytoma. However, vanillylmandelic acid (VMA) is not the analyte of choice to rule out a diagnosis of pheochromocytoma. Recommended tests for that purpose include: -PMET / Metanephrines, Fractionated, Free, Plasma -METAF / Metanephrines, Fractionated, 24 Hour, Urine -CATU / Catecholamine Fractionation, Free, 24 Hour, Urine Necessary Information 1. Patients age is required. 2. Collection duration and urine volume are required. 3. All patients receiving L-dopa should be identified to the laboratory when this test is ordered. 4.Bactrim may interfere with detection of the analyte. All patients taking Bactrim should be identified to the laboratory when this test is ordered. ORDER QUESTIONS AND ANSWERS
Specimen Required Defines the optimal specimen required to perform the test and the preferred volume to complete testing Patient Preparation: Administration of L-dopa may falsely-increase vanillylmandelic acid results; it should be discontinued 24 hours prior to and during collection of specimen. Supplies: Urine Tubes, 10 mL (T068) Specimen Volume: 5 mL Collection Instructions: 1. Collect a 24-hour urine specimen. 2. Add 25 mL of 50% acetic acid as preservative at the start of collection. If specimen is refrigerated during collection, preservative may be added up to 12 hours after collection. Use 15 mL of 50% acetic acid for children <5 years old. This preservative is intended to achieve a pH of between approximately 1 and 5. If necessary, adjust urine pH to 1 to 5 with 50% acetic or hydrochloric acid. Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens in Special Instructions for multiple collections. Special Instructions Library of PDFs including pertinent information and forms related to the test
Forms Urine Preservative Collection Options Note: The addition of preservative or application of temperature controls must occur within 4 hours of completion of the collection.
Specimen Minimum Volume Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory 2 mL Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected All specimens will be evaluated at Mayo Clinic Laboratories for test suitability. Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
Useful For Suggests clinical disorders or settings where the test may be helpful Screening children for catecholamine-secreting tumors with a 24-hour urine collection when requesting testing for only vanillylmandelic acid 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: <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): <8.0 mg/24 hours Interpretation Provides information to assist in interpretation of the test results Vanillylmandelic acid and/or homovanillic acid concentrations are elevated in most patients (more than 90%) 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 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 Values are more commonly elevated during a hypertensive episode. Values may be normal in some individuals with pheochromocytoma. All patients taking Bactrim should be identified to the laboratory when VMA and HVA tests are ordered due to potential interference. Clinical Reference Recommendations for in-depth reading of a clinical nature 1. Hyland K: Disorders of neurotransmitter metabolism. In: Blau N, Duran M, Blaskovics ME, Gibson KM, eds. Physician's Guide to the Laboratory Diagnosis of Metabolic Diseases. Springer; 2003:107-122. doi: 10.1007/978-3-642-55878-8_8 2. Gitlow SE, Bertrani LM, Rausen A, Gribetz D, Dziedzic SW: Diagnosis of neuroblastoma by qualitative and quantitative determination of catecholamine metabolites in urine. Cancer. 1970 Jun;25(6):1377-1383 3. Strenger V, Kerbl R, Dornbusch HJ, et al: Diagnostic and prognostic impact of urinary catecholamines in neuroblastoma patients. Pediatr Blood Cancer. 2007 May;48(5):504-509 4. Barco S, Gennai I, Reggiardo G, et al: Urinary homovanillic and vanillylmandelic acid in the diagnosis of neuroblastoma: report from the Italian Cooperative Group for Neuroblastoma. Clin Biochem. 2014 Jun;47(9):848-852 5. Matthay KK, Maris JM, Schleiermacher G, et al: Neuroblastoma. Nat Rev Dis Primers. 2016 Nov 10;2:16078. doi: 10.1038/nrdp.2016.78 Special Instructions Library of PDFs including pertinent information and forms related to the test
Method Description Describes how the test is performed and provides a method-specific reference Vanillylmandelic acid (VMA) is measured by solid-phase extraction (SPE) of a 1-mL aliquot of urine. A known amount of stable-isotope labeled VMA internal standard (IS) is added to each urine specimen prior to SPE. VMA and IS are eluted from the SPE column with methanol. The methanol is evaporated and the VMA and IS are redissolved in liquid chromatography tandem-mass spectrometry (LC-MS/MS) mobile phase. A portion of this prepared extract is injected onto a LC column that separates VMA and IS from the bulk of any remaining specimen matrix. The VMA and IS are measured by tandem-mass spectrometry using the selected reaction monitoring mode. VMA is quantified using the ratio to IS versus urine calibrators.(Magera MJ, Thompson AL, Stoor AL, et al: Determination of vanillylmandelic acid in urine by stable isotope dilution and electrospray tandem mass spectrometry. Clin Chem. 2003;49:825-826; Eisenhofer G, Grebe S, Cheung NV: Monoamine-producing tumors. In Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:chap 63) PDF Report Indicates whether the report includes an additional document with charts, images or other enriched information No Day(s) Performed Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day. Monday through Friday Report Available The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing. 3 to 5 days Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded 1 week Performing Laboratory Location Indicates the location of the laboratory that performs the test Rochester Fees Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product. This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration. CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing. CPT codes are provided by the performing laboratory. 84585 LOINC® Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
Test Setup Resources Setup Files |
Which client instruction is important when the client is scheduled for a vanilla mandelic acid test?
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