Newcastle Laboratories

HMMA (4-hydroxy-3-methoxy-mandelate), urine

Clinical Background:

Neuroblastoma is a neoplastic disease of infants and early childhood and is the third most common malignant cancer tumours in paediatric patients. Approximately 80% are found in children under 5 ye...

Neuroblastoma is a neoplastic disease of infants and early childhood and is the third most common malignant cancer tumours in paediatric patients. Approximately 80% are found in children under 5 years of age. Elevated values of homovanillic acid (HVA, a metabolite of dopamine) and HMMA/VMA (a metabolite of metadrenalines), may be suggestive of the presence of neuroblastoma. HVA and HMMA/VMA can be used for the diagnosis and follow up treatment of neuroblastoma. Early studies showed that the long term survival rate of these patients could be readily diagnosed using HMMA/HVA ratios.

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Test Details

  • Discipline:

    Biochemistry

    Biochemistry

  • Specimen Container Adult:

    Test not available for adults

    Test not available for adults

  • Specimen Container Paediatric:

    Random urine collection: white universal container [sent to lab immediately]

    Random urine collection: white universal container [sent to lab immediately]

  • Minimum Volume Adult:

    N/A

    N/A

  • Minimum Volume Paediatric:

    1 - 10 mL urine

    1 - 10 mL urine

  • Special Requirement:

    This test (with HVA) is used only for neuroblastoma screening. To test for phaeochromocytomam measure plasma or urine metadrenalines.

    This test (with HVA) is used only for neuroblastoma screening. To test for phaeochromocytomam measure plasma or urine metadrenalines.

  • Sample Stability:

    Once pH has been adjusted to 3.0-3.5, samples are stable at 4°C for up to 10 days.

    For long-term storage, store samples at –20°C.

    Once pH has been adjusted to 3.0-3.5, samples are stable at 4°C for up to 10 days.

    For long-term storage, store samples at –20°C.

  • Transport Requirements:

    Ambient temperature.

    Ambient temperature.

  • Interpretation:

    HMMA and/or HVA concentrations are elevated in more than 90% of patients with neuroblastoma; both tests should be performed. A positive test could be due to a genetic or nongenetic condition. Addit...

    HMMA and/or HVA concentrations are elevated in more than 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 HMMA values are suggestive of a pheochromocytoma, but they are not diagnostic.

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  • Reference Ranges:

    0 - 1 year:        3.5 - 12.0 µmol/mmol creatinine
    1 - 3 years:      3.1 - 11.0 µmol/mmol creatinine
    3 - 6 years:      2.0 - 6.5 µmol/mmol creatinine
    6 - 10 years:    1.8 - 5.0 µmol/mmol creatinine...

    0 - 1 year:        3.5 - 12.0 µmol/mmol creatinine
    1 - 3 years:      3.1 - 11.0 µmol/mmol creatinine
    3 - 6 years:      2.0 - 6.5 µmol/mmol creatinine
    6 - 10 years:    1.8 - 5.0 µmol/mmol creatinine
    10 - 16 years:  1.0 - 4.0 µmol/mmol creatinine

    Adults:             0.9 - 2.4 µmol/mmol creatinine

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  • Factors Affecting Result:

    Urine sample must be sent to the lab immediately, to be frozen upon receipt.

    Administration of L-dopa may falsely increase HMMA results. Patients receiving L-dopa should stop taking it for 24 hour...

    Urine sample must be sent to the lab immediately, to be frozen upon receipt.

    Administration of L-dopa may falsely increase HMMA 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 HMMA and HVA tests are ordered.

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  • Routine Contact Name:

    Duty Biochemist

  • Routine Telephone:

    Freeman: 0191 244 8889
    RVI: 0191 282 9719

    Freeman: 0191 244 8889
    RVI: 0191 282 9719

  • Routine Email:

  • Specialist Test:

    Yes

    Yes

Availability:

Sample sent to an external laboratory for testing.

Turn Around:

3 weeks

Send To:

Department of Blood Sciences

Freeman Hospital
Freeman Road
Newcastle upon Tyne
NE7 7DN

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