Human chorionic gonadotropin measurements in parathyroid carcinoma.
OBJECTIVE
Preoperatively, it is difficult to differentiate between parathyroid cancer (PtCa) and severe primary hyperparathyroidism (PHPT) due to a benign tumor. Human chorionic gonadotropin (hCG) is a tumor marker in trophoblastic and nontrophoblastic cancers and hyperglycosylated hCG is increased in hCG-secreting malignancies. We investigated whether hCG can distinguish PtCa cancer from benign disease and add prognostic information.


METHODS
Observational study.


METHODS
Measurement of urinary hCG (total and malignant isoforms) and serum malignant hCG in 8 subjects with PtCa and in 18 subjects with PHPT (measurement of urine in ten and serum in eight).


RESULTS
Total urinary hCG was normal in the benign PHPT control subjects (range: 0-17 fmol/mg Cr; nl<50). In the PtCa subjects, three had normal total urinary hCG levels and survived complication free for at least 2 years; three had persistently elevated total urinary hCG levels (range: 217-1986 fmol/mg Cr) and sustained hip fracture (n=3) and died (n=2) within 3 and 6 months respectively; two had a rise in total urinary hCG and had hip fracture (n=1) and died (n=2) within 4 and 10 months respectively. Elevated urinary hCG was of the malignant hyperglycosylated isoform. Serum malignant hyperglycosylated hCG values in all of the cancer patients exceeded the maximal serum malignant hCG level of the PHPT subjects with benign disease (3.77 pmol/l).


CONCLUSIONS
hCG, especially its hyperglycosylated isoform, might add diagnostic and prognostic information in PtCa. Further studies would help to elucidate the role of hCG as a potential tumor marker in this disease.
Rubin
Mishaela R
MR
Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, New York 10032, USA. mrr6@columbia.edu
Bilezikian
John P
JP
Birken
Steven
S
Silverberg
Shonni J
SJ
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood* / Q000652:urine*; D002118:Calcium / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood* / Q000652:urine*; D000069449:Cinacalcet; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000008:administration & dosage; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism*; D011379:Prognosis
D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D009281:Naphthalenes; D010281:Parathyroid Hormone; D002118:Calcium; D000069449:Cinacalcet