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Vanillylmandelic Acid (VMA) Urine Test

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

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Clinical Information 

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.

Why Get Tested?

To help diagnose or rule out a neuroblastoma or other neuroendocrine tumor; to monitor the effectiveness of treatment

Interpretation 

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 

Values are more commonly elevated during a hypertensive episode.

Values may be normal in some individuals with pheochromocytoma.

Sample Required:

  1. The test is done in the urine.
  2. Collect 24 hours urine sample.
    1. Discard the first urine sample and not the time. Now collect all urine samples in the container containing 6 mL of HCl. Collect the last sample when 24 hours are completed.
    2. Or add 20 mL oh HCL (6mol/L)
  3. Refrigerate the urine during collection and is stable for 2 weeks.
  4. The sample is stable for 2 weeks at 2 to 4 °C.

Precautions for Sample:

  1. Following foods and drugs cause the false raised level of VMA.
  2. Avoid intake of chocolate, coffee, tea, and cocoa for 2 to 3 days before the test is performed.
  3. Avoid food like citrus fruits, banana, and food with vanilla.
  4. Avoid beer and red wine.
  5. Avoid drugs like aspirin and antihypertensive medicines.
  6. Vigorous exercise and stress may increase the VMA level.
  7. Decreased VMA levels may be seen in patients with uremia, alkaline urine, and radiographic contrast media.
  8. Drugs that may increase the level are levodopa, lithium, nitroglycerine, epinephrine, and caffeine.
  9. Drugs that may decrease the level are phenothiazine, reserpine, guanethidine, monoamine oxidase inhibitor, and disulfiram.

Normal Values:

Source 1

VMA 

Agemg/day
0 to 10 day<1.0
10 days to 24 months<2.0
24 months to 18 years<5.0
Adult2.1 to 7.6

Source 2

  • Adult/elderly = <6.8 mg/24 hours
  • Adolescent = 1 to 5 mg/24 hours
  • Child     =  1 to 3 mg/24 hours
  • Infants = <2 mg/24 hours
  • Newborn = <1 mg/24 hours

Other sources

TestUrine samplePlasma
VMAup to 9 mg/24 hours
VMA Some reference says2.1 to 7.6 mg/24 hours
Catecholamines total<100 µg/ 24 hours
Epinephrine0 to 20 µg/ 24 hours<50 pg/mL
Metanephrine74 to 297 µg/ 24 hours
Norepinephrine15 to 80 µg/ 24 hours110 to 410 pg/mL
Dopamine65 to 400 µg/ 24 hours<87 pg/mL

Increased VMA Level Is Seen In:

  1. Adrenal glands tumor (Pheochromocytoma)
  2. May be seen in any major stress like:
    1. Burns.
    2. Body infections ( sepsis).
    3. Surgery or traumatic injury.
  3. Many blood pressure drugs.
  4. Neuroblastoma.
  5. Ganglioblastoma.
  6. ganglioneuroma.
  7. Carcinoid tumors.

Decreased VMA Level Is Seen In:

  1. In Diabetes
  2. Parkinsonism.

Increased Catecholamine Is Seen In:

  1. Pheochromocytoma.
  2. Neuroblastoma.
  3. Ganglioneuroma.
  4. Diabetic acidosis.
  5. Hypothyroidism.
  6. Myocardial infarction.

Decreased Catecholamine Is Seen In:

  1. Parkinsonism.
  2. Diabetic neuropathy.

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