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.
Hwang
David
D
Trophoblastic Disease Centre, Sheffield, UK.
Hancock
Barry W
BW
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