Management of persistent, unexplained, low-level human chorionic gonadotropin elevation: a report of 5 cases.
BACKGROUND
Persistent low-level elevation of human chorionic gonadotropin (hCG) without a history of gestational trophoblastic disease has often been treated unsuccessfully with chemotherapy and/or hysterectomy on the presumption that this was trophoblastic disease.


METHODS
We report on 5 patients diagnosed with this condition who were closely monitored and did not receive intensive or prolonged chemotherapy. Four patients received a short therapeutic trial of methotrexate without a significant change in hCG levels. All patients have remained healthy. Three patients successfully conceived, and 2 delivered healthy infants.


CONCLUSIONS
Immediate chemotherapy or hysterectomy can be avoided in patients with persistent, unexplained, low-level elevation of hCG. Failure of normalization of hCG levels with chemotherapy suggests that highly differentiated normal trophoblastic noninvasive cells, rather than invasive cytotrophoblastic cells, are responsible.
Trophoblastic Disease Centre, Sheffield, UK.
David
D
Hwang
Barry W
BW
Hancock
D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D014327:Trophoblasts / Q000502:physiology
D018906:Antineoplastic Agents, Alkylating; D006063:Chorionic Gonadotropin; D008727:Methotrexate