Ordering Recommendation

Initial test for the diagnosis and monitoring of neuroblastoma. Should be ordered concurrently with Homovanillic Acid (HVA), Urine (0080422).

New York DOH Approval Status

This test is New York state approved.

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


Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry


Sun, Tue, Wed, Thu, Fri, Sat


1-5 days

Reference Interval

Test Number
Reference Interval
  Creatinine, Urine - per 24h
Male (mg/d)
Female (mg/d)
3-8 years 140-700 140-700
9-12 years 300-1300 300-1300
13-17 years 500-2300 400-1600
18-50 years 1000-2500 700-1600
51-80 years 800-2100 500-1400
81 years and older 600-2000 400-1300

  Vanillylmandelic Acid - per 24h 18 years and older:  0.0-7.0 mg/d
  Vanillylmandelic Acid - ratio to CRT
Age mg/g CRT
0-2 years 0-27
3-5 years 0-13
6-17 years 0-9
18 years and older 0-6

Interpretive Data

Vanillylmandelic acid (VMA) results are expressed as a ratio to creatinine excretion (mg/g CRT). 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.

Per 24h calculations are provided to aid interpretation for collections with a duration of 24 hours and an average daily urine volume. For specimens with notable deviations in collection time or volume, ratios of analytes to a corresponding urine creatinine concentration may assist in result interpretation.

This test was developed and its performance characteristics determined by ARUP Laboratories. It has not been cleared or approved by the US Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes.

Compliance Category

Laboratory Developed Test (LDT)


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.

Hotline History


CPT Codes



Component Test Code* Component Chart Name LOINC
0020207 Creatinine, Urine - per volume 2161-8
0020208 Creatinine, Urine - per 24h 2162-6
0080401 Vanillylmandelic Acid - per 24h 3122-9
0080402 Vanillylmandelic Acid Interpretation 50948-9
0081306 Vanillylmandelic Acid - per volume 9624-8
0081341 Vanillylmandelic Acid - ratio to CRT 30571-4
0097110 Total Volume 19153-6
0097111 Hours Collected 30211-7
* 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.


  • 3-Methoxy-4-Hydroxy-Mandelic Acid
  • 3-Methoxy-4-Hydroxymandelic Acid
  • 4-Hydroxy-3-Methoxymandelic Acid
  • VMA
Vanillylmandelic Acid (VMA), Urine