The Excretion of 4-hydroxy-3-methoxy-mandelic Acid by Children.

Much interest has been shown recently in the urinary excretion of 4-hydroxy-3-methoxy-mandelic acid (HMMA, but also known as VMA). It is accepted that its estimation may assist in the diagnosis of neuroblastoma and phaeochromocytoma, the high excretion usually found with these tumours being well above that possibly due to dietary constitutents, the stress of hospital admission, or recent operation. While most workers in describing methods or investigating clinical groups have included small numbers of normal subjects in order to define normal values of excretion, there have been no systematic studies of the excretion pattern in childhood. This paper records a study of 24-hour HMMA excretion in 132 normal children and in several small groups of children suffering from conditions that have been suspected of raising excretion rates ofHMMA. In the series of children with proven neuroblastoma, as in those of most other workers, there are a few with normal HMMA excretion. Some of the non-pathological factors that might influence HMMA excretion have also been studied. Subjects and Methods The following children provided 24-hour specimens of urine: