title: Management and outcome of healthy women with a persistently elevated beta-hCG.
abstract: OBJECTIVE
  Raised serum beta human chorionic gonadotrophin (beta-hCG) not due to pregnancy can occur as a consequence of (1) gestational trophoblastic neoplasia (GTN), (2) non-gestational trophoblastic tumours, (3) a false-positive beta-hCG, (4) the menopause or (5) a high normal level. Accurate differentiation between these causes is vital to avoid potentially inappropriate investigations and therapies, which may induce infertility or other serious adverse events. Here we report the United Kingdom experience of patients with an elevated beta-hCG of initial uncertain cause and provide a clinical algorithm for the management of such cases.
  
  
  METHODS
  The Charing Cross and Weston Park Hospital GTN databases were screened to identify patients referred with an elevated beta-hCG who were not pregnant and had no previous diagnosis of GTN.
  
  
  RESULTS
  Between 1981 and 2004 fourteen women presented with persistently raised serum beta-hCG resulting in diagnostic problems. False-positive beta-hCG was excluded in all. Three patients developed gestational choriocarcinoma after 9-29 months. However, in 11 women no cause for the persistently elevated beta-hCG was found. One of these achieved chemotherapy-induced normalisation of serum beta-hCG, but the remaining 10 underwent surgery and/or chemotherapy without benefit. Thus, 71% (10/14) of patients remain well with unexplained elevated beta-hCG levels.
  
  
  CONCLUSIONS
  Elevated serum and urinary beta-hCG levels in healthy women should be investigated systematically to exclude an underlying malignant process and to avoid inappropriate surgical and medical intervention. Long-term follow-up is required as tumours may not become apparent for many months or years.
authors.affiliation: Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London, UK.
authors.forename: Carlo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Tony
authors.initials: T
authors.lastname: Dhillon
authors.forename: Rosemary Ann
authors.initials: RA
authors.lastname: Fisher
authors.forename: Anna-Mary
authors.initials: AM
authors.lastname: Young
authors.forename: Delia
authors.initials: D
authors.lastname: Short
authors.forename: Hugh
authors.initials: H
authors.lastname: Mitchell
authors.forename: Carol
authors.initials: C
authors.lastname: Aghajanian
authors.forename: Philip Michael
authors.initials: PM
authors.lastname: Savage
authors.forename: Edward Stewart
authors.initials: ES
authors.lastname: Newlands
authors.forename: Barry W
authors.initials: BW
authors.lastname: Hancock
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Seckl
mesh_terms: D000328:Adult; D002822:Choriocarcinoma / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D014328:Trophoblastic Neoplasms / Q000097:blood*; D014594:Uterine Neoplasms / Q000097:blood*
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human