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Test ID: HVA Homovanillic Acid (HVA), 24 Hour, Urine

Reporting Name

Homovanillic Acid (HVA), 24 Hr, U

Useful For

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

 

Monitoring neuroblastoma treatment

 

Screening patients with possible inborn errors of catecholamine metabolism

Specimen Type

Urine


Necessary Information


1. Collection duration and urine volume are required.

2. Patient's age is required.



Specimen Required


Container/Tube: Plastic, 10-mL urine tube (T068)

Specimen Volume: 5 mL

Collection Instructions:

1. Collect a 24-hour urine specimen.

2. 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 less than 5 years old. This preservative is intended to achieve a pH of between approximately 1 and 5. If necessary, adjust urine pH to 1 to 5 with 50% acetic or HCI acid.

Additional Information:

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

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

3. See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens in Special Instructions for multiple collections.

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 Minimum Volume

2 mL

Specimen Stability Information

Specimen Type Temperature Time
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 mg/24 hours

Day(s) and Time(s) Performed

Monday through Friday; 8 a.m.

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. 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

Clinical Information

Homovanillic acid (HVA) and other catecholamine metabolites (vanillylmandelic acid [VMA] and dopamine) are typically elevated in patients with catecholamine-secreting tumors (eg, neuroblastoma, pheochromocytoma, and other neural crest tumors). HVA and VMA levels may also be useful in monitoring patients who have been treated as a result of the above-mentioned tumors. HVA levels may also be altered in disorders of catecholamine metabolism; monoamine oxidase-A deficiency can cause decreased urinary HVA values, while a deficiency of dopamine beta-hydrolase (the enzyme that converts dopamine to norepinephrine) can cause elevated urinary HVA values.

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. Hyland K, Biaggioni I, Elpeleg OH, et al: Disorders of neurotransmitter metabolism. In Physician's Guide to the Laboratory Diagnosis of Metabolic Disease, Chapman and Hall Medical. Edited by N Blau, M Duran, ME Blaskovics. London, UK. 1996, pp 79-98

2. Hyland K: Presentation, diagnosis, and treatment of the disorders of monoamine neurotransmitter metabolism. Sem Perinatol 1999;23:194-203

3. Strenger V, Kerbl R, Dornbusch HJ, et al: Diagnostic and prognostic impact of urinary catecholamines in neuroblastoma patients. Pediatr Blood Cancer 2007;48:504-509

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 June;47(9):848-852

Analytic Time

2 days (not reported on Sunday)

Method Name

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

Urine Preservative Collection Options

Ambient

No

Refrigerated

No

Frozen

No

6N HCl

Yes

50% Acetic Acid

Preferred

Na2CO3

No

Toluene

No

6N HNO3

No

Boric Acid

No

Thymol

No

Forms

If not ordering electronically, complete, print, and send an Oncology Test Request Form (T729) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/oncology-request-form.pdf)

Mayo Medical Laboratories | Genetics and Pharmacogenomics Catalog Additional Information:

mml-biochemical