Management and outcome of healthy women with a persistently elevated beta-hCG.
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.
Palmieri
Carlo
C
Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London, UK.
Dhillon
Tony
T
Fisher
Rosemary Ann
RA
Young
Anna-Mary
AM
Short
Delia
D
Mitchell
Hugh
H
Aghajanian
Carol
C
Savage
Philip Michael
PM
Newlands
Edward Stewart
ES
Hancock
Barry W
BW
Seckl
Michael J
MJ
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*
D018997:Chorionic Gonadotropin, beta Subunit, Human