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EPIC ORDER CODE LAB401 Homovanillic Acid, 24 Hour, Urine

Additional Codes

SQ: UHVAM

Reporting Name

Homovanillic Acid (HVA), 24 Hr, U

Useful For

Screening children for catecholamine-secreting tumors using a 24-hour urine collection when requesting homovanillic acid only

 

Monitoring neuroblastoma treatment

 

Screening patients with possible inborn errors of catecholamine metabolism

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Urine


Necessary Information


1. Collection duration and urine volume in milliliters are required.

2. Patient's age is 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.



Specimen Required


Patient Preparation: Administration of L-dopa may falsely increase homovanillic acid results; it should be discontinued 24 hours prior to and during specimen collection.

Supplies: Urine Tubes, 10 mL (T068)

Container/Tube: Plastic, 10-mL urine tube

Specimen Volume: 5 mL

Collection Instructions:

1. Add 25 mL of 50% acetic acid as preservative at 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 younger than 5 years. This preservative is intended to achieve a pH of between approximately 1 and 5.

2. Collect a 24-hour urine specimen.

3. If necessary, adjust urine pH to a level between 1 and 5 by adding 50% acetic acid or hydrochloric acid dropwise and checking the pH.

Additional Information:

1. The sensitivity of this test is greater on a 24-hour specimen than on a random specimen.

2. See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens for multiple collections.


Specimen Minimum Volume

2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 28 days
  Frozen  180 days

Reference Values

<1 year: <35.0 mg/g creatinine

1 year: <30.0 mg/g creatinine

2-4 years: <25.0 mg/g creatinine

5-9 years: <15.0 mg/g creatinine

10-14 years: <9.0 mg/g creatinine

≥15 years (adults): <8.0 mg/24 hours

Day(s) Performed

Monday through Friday

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83150

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HVA Homovanillic Acid (HVA), 24 Hr, U 13760-4

 

Result ID Test Result Name Result LOINC Value
3572 Homovanillic Acid, Adult (>14 yr) 2436-4
3573 Homovanillic Acid, Child (<15 yr) 13760-4
TM39 Collection Duration 13362-9
VL37 Urine Volume 3167-4

Interpretation

Vanillylmandelic acid (VMA) and/or homovanillic acid (HVA) concentrations are elevated in over 90% of patients 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 HVA values are suggestive of a deficiency of dopamine beta-hydrolase, a neuroblastoma, a pheochromocytoma, or may reflect administration of L-dopa.

 

Decreased urinary HVA values may suggest monoamine oxidase-A deficiency.

Clinical Reference

1. Eisenhofer G. Monoamine-producing tumors. In: Rifai N, Chiu RWK, Young I, Burnham CD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:765

2. Ormazabal A, Molero-Luis M, Garcia-Cazorla A, Artuch R. Biomarkers for the study of catecholamine and serotonin genetic diseases. In: Garg U, Smith LD, eds. Biomarkers in Inborn Errors of Metabolism: Clinical Aspects and Laboratory Determination. Elsevier; 2017:301-329.

3. Strenger V, Kerbl R, Dornbusch HJ, et al. Diagnostic and prognostic impact of urinary catecholamines in neuroblastoma patients. Pediatr Blood Cancer. 2007;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;47(9):848-852

5. Matthay KK, Maris JM, Schleiermacher G, et al. Neuroblastoma. Nat Rev Dis Primers. 2016;2:16078. doi: 10.1038/nrdp.2016.78

Method Description

Homovanillic acid (HVA) is measured by solid-phase extraction (SPE) of a 1-mL aliquot of urine. A known amount of stable-isotope labeled HVA internal standard (IS) is added to each urine specimen prior to SPE. HVA and IS are eluted from the SPE column with methanol. The methanol is evaporated, and the HVA 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 HVA and IS from the bulk of any remaining specimen matrix. The HVA and IS are measured by mass spectrometry/tandem-mass spectrometry using the selected reaction monitoring mode. HVA is quantified using the ratio to IS versus urine calibrators.(Magera MJ, Stoor A, Helgeson JK, Matern D, Rinaldo P. Determination of homovanillic acid in urine by stable isotope dilution and electrospray tandem mass spectrometry. Clin Chim Acta. 2001;306[1-2]:35-41; 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)

Report Available

2 to 4 days

Specimen Retention Time

7 days

Reject Due To

  All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Method Name

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

Disease States

  • Neuroblastoma

Urine Preservative Collection Options

Note: For preservative or application of temperature controls timing, see Specimen Required.

Ambient (No additive)

No

Refrigerate (No additive)

No

Frozen (No additive)

No

50% Acetic Acid

Preferred

Boric Acid

No

Diazolidinyl Urea

No

6M Hydrochloric Acid

OK

6M Nitric Acid

OK

Sodium Carbonate

No

Thymol

No

Toluene

No

Forms

If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.