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Test Code HGEMP Hydroxyglutaric Acids, Glutaric Acid, Ethylmalonic Acid, and Methylsuccinic Acid, Plasma

Useful For

Evaluation of patients with an abnormal newborn screen showing elevations of glutarylcarnitine (C5-DC) using plasma specimens

 

Evaluation of patients with abnormal newborn screens showing elevations of C4- acylcarnitine to aid in the differential diagnosis of short chain acyl-CoA dehydrogenase and isobutyryl-CoA dehydrogenase deficiencies

 

Diagnosis of glutaric acidemia type 1

 

Aiding in diagnosis of glutaric acidemia type 2

Method Name

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

Reporting Name

HGEM, P

Specimen Type

Plasma


Necessary Information


Patient's age is required.



Specimen Required


Collection Container/Tube:

Preferred: Green top (sodium heparin)

Acceptable: Lavender top (EDTA), green top (lithium heparin)

Submission Container/Tube: Plastic vial

Specimen Volume: 0.1 mL

Collection Instructions: Centrifuge and aliquot plasma into a plastic vial.


Specimen Minimum Volume

0.02 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Plasma Refrigerated (preferred) 90 days
  Frozen  90 days
  Ambient  12 days

Reference Values

2-OH Glutaric acid ≤4.5 nmol/mL

3-OH Glutaric acid ≤0.7 nmol/mL

Glutaric acid ≤0.8 nmol/mL

Methylsuccinic acid ≤0.3 nmol/mL

Ethylmalonic acid ≤1.5 nmol/mL

Interpretation

Elevations of ethylmalonic acid (EMA) and methylsuccinic acid (MSA) are consistent with a diagnosis of short chain acyl Co-A dehydrogenase (SCAD) deficiency.

 

Elevation of EMA is consistent with a diagnosis of ethylmalonic encephalopathy.

 

Normal levels of EMA in the context of elevated C4 is consistent with a diagnosis of isobutyryl-CoA dehydrogenase (IBDH) deficiency.

 

Elevation of glutaric acid (GA) and 3-hydroxyglutaric acid (3OH-GA) are consistent with a diagnosis of glutaric acidemia type I (GA1).

 

Elevation of GA, 2-hydroxyglutaric acid (2OH-GA), 3OH-GA, EMA, and MSA are consistent with a diagnosis of glutaric acidemia type II (GA2).

Clinical Reference

1. Rinaldo P, Cowan TM, Matern D. Acylcarnitine profile analysis. Genet Med. 2008;10(2):151-156

2. Vockley J, Zschocke J, Knerr I, Vockley C, Michael Gibson KK. Branched chain organic acidurias. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA. eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed March 30, 2023. Available at https://ommbid.mhmedical.com/content.aspx?bookid=2709&sectionid=225085758

3. Frerman FE, Goodman SI. Defects of electron transfer flavoprotein and electron transfer flavoprotein-ubiquinone oxidoreductase: Glutaric acidemia type II. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA, eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed March 30, 2023. Available at https://ommbid.mhmedical.com/content.aspx?bookid=2709&sectionid=225088261

4. Larson A, Goodman S. Glutaric acidemia type 1. In: Adam MP, Mirzaa GM, Pagon RA, et al, eds. GeneReviews [Internet]. University of Washington, Seattle; 2019. Accessed March 30, 2023. Available at www.ncbi.nlm.nih.gov/books/NBK546575/

5. Di Meo I, Lamperti C, Tiranti V. Ethylmalonic encephalopathy. In: Adam MP, Mirzaa GM, Pagon RA, et al, eds. GeneReviews [Internet]. University of Washington, Seattle; 2017. Accessed March 30, 2023. Available at www.ncbi.nlm.nih.gov/books/NBK453432/

6. Wolfe L, Jethva R, Oglesbee D, Vockley J. Short-chain acyl-CoA dehydrogenase deficiency. In: Adam MP, Mirzaa GM, Pagon RA, et al. eds. GeneReviews [Internet]. University of Washington, Seattle; 2011. Updated August 9, 2018. Accessed March 30, 2023. Available at www.ncbi.nlm.nih.gov/books/NBK63582/

Day(s) Performed

Monday, Wednesday

Report Available

3 to 7 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83918

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HGEMP HGEM, P 92673-3

 

Result ID Test Result Name Result LOINC Value
36062 2-OH Glutaric acid 69845-6
36063 3-OH Glutaric acid 69851-4
36064 Glutaric acid 27301-1
36065 Methylsuccinic acid 69829-0
36066 Ethylmalonic acid 79476-8
36067 Interpretation (HGEMP) 59462-2
36068 Reviewed By 18771-6