Ordering Recommendation

Initial test for the diagnosis and monitoring of 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.
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

Reference Interval
Vanillylmandelic Acid - per 24h 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
Vanillylmandelic Acid - ratio to CRT 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, Urine - per 24h 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: For laboratory developed tests not using a RUO kit, and for FDA approved, cleared or 510(k) exempt assays with alterations. 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.

Hotline History
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 26706-2
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