<prompt> V.M.A levels are elevated in all except?PheochromocytomaNeuroblastomaCarcinoid tumorParaganglinoma  <response>: Vanillylmandelicacid,urineVMA 15mggcreatinine Catecholaminesaresecretedin excessbypheochromocytomasand otherneuralcresttumors,andare metabolizedbytheenzymes monoamineoxidaseandcatechol-OmethyltransferasetoVMA,whichis excretedinurine. Increasedin:Pheochromocytoma 64sensitivity,95specificity, neuroblastoma,ganglioneuroma, generalizedanxiety. Decreasedin:Drugs:monoamine oxidaseinhibitorsMAOIs,eg, phenelzine. Elevated VMA level is suggestive of pheochromocytoma, but is not diagnostic. A normal VMA level does not rule out pheochromocytoma. Test is usually ordered along with homovanillic acid HVA on random urine sample for screening children for catecholamine-secreting tumors eg, neuroblastoma and other neural crest tumors, and for monitoring patients who have had treatment for these tumors. 