Which adrenal medulla tumor is typically associated with increased VMA but not HVA?

• A. Pheochromocytoma
• B. Neuroblastoma
• C. Ganglioneuroma
• D. Adrenal cortical carcinoma

Answer: (A)

Catecholamine metabolites in urine reveal which substance is driving the tumor’s secretions. VMA is the end product of catecholamines like epinephrine and norepinephrine, while HVA is a metabolite of dopamine. Pheochromocytoma arises from adrenal medullary chromaffin cells and mainly secretes epinephrine and norepinephrine, so you typically see elevated VMA in urine. Dopamine secretion is not the hallmark of pheochromocytoma, so HVA is not consistently raised. By contrast, neuroblastoma often increases both VMA and HVA because it can produce dopamine as well as norepinephrine and epinephrine; ganglioneuroma is usually nonsecretory; and adrenal cortical carcinoma arises from the cortex and doesn’t elevate these catecholamine metabolites. So the tumor most characteristically associated with increased VMA but not HVA is pheochromocytoma.