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26139 Homovanillic Acid, 24 Hour, Urine (HVA)

Homovanillic Acid, 24 Hour, Urine (HVA)
Test Code: HVASO
Synonyms/Keywords
​HVA (Homovanillic Acid)
Neuroblastoma Profile
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 Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No ​Urine ​Urine Plastic Container ​ ​5 mL ​2 mL ​2 mL
Collection Processing Instructions
​Patient Preparation: Administration of L-dopa may falsely increase homovanillic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
Collection Instructions:
1.      Collect a 24-hour urine specimen. 
2.      Collection duration and urine volume are required.
3.      Patient’s age is required.
4.    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:
    -The sensitivity of this test is greater on a 24-hour specimen than on a random specimen.
Specimen Stability Information
Specimen Type Temperature Time
​Urine ​ ​Refrigerate (preferred) ​28 days
​Frozen ​180 days
Interference

Administration of L-dopa may falsely increase homovanillic acid (HVA) results. Patients receiving L-dopa should stop taking it for 24 hours before and during the collection.

All patients receiving L-dopa should be identified to the laboratory when vanillylmandelic acid (VMA) and HVA tests are ordered.

All patients taking Bactrim should be identified to the laboratory when VMA and HVA tests are ordered due to potential interference.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday through Friday ​2-4 days Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reference Lab
Mayo Clinic Laboratories
Test Information
Homovanillic acid (HVA) and other catecholamine metabolites (vanillylmandelic acid: [MA 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.
Reference Range Information
Performing Location Reference Range
​Mayo Clinic Laboratories ​<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
> or =15 years (adults): <8 mg/24 hours
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.

Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​83150 ​ ​1 ​ ​
Classification
​
Synonyms/Keywords
​HVA (Homovanillic Acid)
Neuroblastoma Profile
Ordering Applications
Ordering Application Description
​Centricity ​Homovanillic Acid, 24 Hour, Urine (HVA)
​Cerner ​Homovanillic Acid, 24 Hour, Urine (HVA)
​COM ​Homovanillic Acid, 24 Hour, Urine (HVA)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No ​Urine ​Urine Plastic Container ​ ​5 mL ​2 mL ​2 mL
Collection Processing
​Patient Preparation: Administration of L-dopa may falsely increase homovanillic acid results; it should be discontinued 24 hours prior to and during collection of specimen.
Collection Instructions:
1.      Collect a 24-hour urine specimen. 
2.      Collection duration and urine volume are required.
3.      Patient’s age is required.
4.    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:
    -The sensitivity of this test is greater on a 24-hour specimen than on a random specimen.
Specimen Stability Information
Specimen Type Temperature Time
​Urine ​ ​Refrigerate (preferred) ​28 days
​Frozen ​180 days
Interference

Administration of L-dopa may falsely increase homovanillic acid (HVA) results. Patients receiving L-dopa should stop taking it for 24 hours before and during the collection.

All patients receiving L-dopa should be identified to the laboratory when vanillylmandelic acid (VMA) and HVA tests are ordered.

All patients taking Bactrim should be identified to the laboratory when VMA and HVA tests are ordered due to potential interference.

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
Reference Range Information
Performing Location Reference Range
​Mayo Clinic Laboratories ​<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
> or =15 years (adults): <8 mg/24 hours
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.

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday through Friday ​2-4 days Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​83150 ​ ​1 ​ ​
Classification
​
For most current information refer to the Marshfield Laboratory online reference manual.