Hello. Thank you for your question and welcome to HCM. I carefully read your query. A high vanylmandelic acid and other metanephrine levels in urine are indicative of pheochromocytoma. It is a tumor that generally arises in the adrenal glands, approximately in 85-90% of cases. However, there is the rest of 10-15% of cases that it can be originated elsewhere in the body, any organ system that has chromaphine tissue. If you have sudden rises of blood pressure, which cannot be controlled by medication, and/or angry reaction from time to time, and/or combining of changing of you face color from pale to red and vice versa, this is probably pheochromocytoma. I would recommend that you proceed further with a total body scan and have the above mentioned urine tests done again. Also, I would recommend a consult with an endocrinologist and a surgeon, after you have your test results back. I hope I was helpful with my answer. Take care.