4-hydroxy-3-methoxymandelate

Keywords: HMMA, Vanillyl mandelic acid urine

Specimen:

24 h urine collection with HCl as preservative.

A random urine specimen is satisfactory for children.

Method:

HPLC.

Reference Interval:

Depends on method, age of patient; typically < 35 µmol/24 h (adult).

Application:

Investigation of hypertension, particularly paroxysmal hypertension and hypertension in young adults.

Investigation of suspected Neuroblastoma or related tumours.

However Free metanephrines are the preferred first line test in adults.

Interpretation:

Increased 24 h excretion is found with Phaeochromocytoma (particularly if the urine specimen is collected during an hypertensive episode), Neuroblastoma and related tumours.

Excretion may be normal in occasional cases. The stress of severe illness (eg, cardiac failure) may cause increased levels.

Some analytical methods are subject to drug interferences - consult pathologist.

See also Catecholamines urine, Homovanillic acid urine,  Metanephrines urine.

Reference:

Roberts NB et al. Ann Clin Biochem 1992; 29: 678-680.

Kellie SJ et al. Aust Paediatr J 1986; 22: 313-315.

Lendes JWM et al Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline. J. Clin Endocrinology and metabolism 2014; 99(6):1915-1942.