Vanillylmandelic Acid (VMA), Urine
Ordering Recommendation
Initial test for the diagnosis and monitoring of individuals with neuroblastoma. Should be ordered concurrently with Homovanillic Acid (HVA), Urine (0080422).
Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry
Sun, Tue-Sat
1-4 days  
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
Specimen Required
Patient Preparation
Abstain from medications for 72 hours prior to collection.  
24-hour or random urine. Refrigerate 24-hour specimens during collection.  
Specimen Preparation
Transfer 4 mL aliquot from a well-mixed 24-hour or random collection to an ARUP Standard Transport Tube. (Min: 1 mL) Record total volume and collection time interval on transport tube and test request form.  
Storage/Transport Temperature
Unacceptable Conditions
Specimen types other than urine.  
Ambient: Unacceptable; Refrigerated: 1 week; Frozen: 2 weeks  
Reference Interval
Components Reference Interval  
VMA, Urine 18 years and older 0.0-​7.0 mg/d
 The VMA-​to-​creatinine ratio will be reported when the patient is under 18 years, the urine collection is random or other than 24 hours, or the urine volume is less than 400 mL/24 hours  
VMA, Urine 0-​2 years
3-​5 years 
6-​17 years
18 years and older
0-​27 mg/g CRT
0-​13 mg/g CRT
0-​9 mg/g CRT
0-​6 mg/g CRT
Creatinine (24 hour) Male
3-​8 years: 140-​700 mg/d
9-​12 years: 300-​1300 mg/d
13-​17 years: 500-​2300 mg/d
18-​50 years: 1000-​2500 mg/d
51-​80 years: 800-​2100 mg/d
81 years and older: 600-​2000 mg/d
3-​8 years: 140-​700 mg/d
9-​12 years: 300-​1300 mg/d
13-​17 years: 400-​1600 mg/d
18-​50 years: 700-​1600 mg/d
51-​80 years: 500-​1400 mg/d
81 years and older: 400-​1300 mg/d
Interpretive Data
Vanillylmandelic acid (VMA) results are expressed as a ratio to creatinine excretion (mg/g CRT). VMA mass per day (mg/d) is not reported on specimens from patients younger than 18 years of age, or for random specimens, urine collection periods other than 24 hours, or urine volumes less than 400 mL/d. No reference interval is available for results reported in units of mg/L. Slight or moderate increases in catecholamine metabolites may be due to extreme anxiety, essential hypertension, intense physical exercise, or drug interactions. Significant increase of one or more catecholamine metabolites (several times the upper reference limit) is associated with an increased probability of a secreting neuroendocrine tumor.

Compliance Statement B: This test was developed and its performance characteristics determined by ARUP Laboratories. The U.S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.
Moderately elevated VMA (vanillylmandelic acid) can be caused by a variety of factors such as essential hypertension, intense anxiety, intense physical exercise, and numerous drug interactions (including some over-the-counter medications and herbal products).

Medications that may interfere with catecholamines and their metabolites include amphetamines and amphetamine-like compounds, appetite suppressants, bromocriptine, buspirone, caffeine, chlorpromazine, clonidine, disulfiram, diuretics (in doses sufficient to deplete sodium), epinephrine, glucagon, guanethidine, histamine, hydrazine derivatives, imipramine, levodopa (L-dopa, Sinemet®), lithium, MAO inhibitors, melatonin, methyldopa (Aldomet®), morphine, nitroglycerin, nose drops, propafenone (Rythmol), radiographic agents, rauwolfia alkaloids (Reserpine), tricyclic antidepressants, and vasodilators.  The effects of some drugs on catecholamine metabolite results may not be predictable.
CPT Code(s)
Component Test Code*Component Chart NameLOINC
0020207Creatinine, Urine - per volume2161-8
0020208Creatinine, Urine - per 24h2162-6
0080401Vanillylmandelic Acid - per 24h3122-9
0080402Vanillylmandelic Acid Interpretation50948-9
0081306Vanillylmandelic Acid - per volume26706-2
0081341Vanillylmandelic Acid - ratio to CRT30571-4
0097110Total Volume19153-6
0097111Hours Collected30211-7
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
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