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CASE REPORT
Pregnancy, malignancy or mother nature? Persistence of high hCG levels in a perimenopausal woman
  1. Ayşe Y Demir1,
  2. Ruben EA Musson2,
  3. Willem A Schöls3 and
  4. Jitze M Duk3
  1. 1 Laboratory for Clinical Chemistry and Haematology, Meander Medical Center, Amersfoort, The Netherlands
  2. 2 Laboratory for Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 Department of Gynaecology and Obstetrics, Meander Medical Center, Amersfoort, The Netherlands
  1. Correspondence to Dr Ayşe Y Demir, ay.demir{at}meandermc.nl

Abstract

Despite the fact that a small percentage of peri en postmenopausal women have mild elevations in human chorionic gonadotrophin (hCG) concentrations (<14 IU/L) besides high levels of gonadotrophins, a considerable number of clinicians are not aware of this phenomenon. We report a case of a 53-year-old woman with an unusually high hCG concentration (>40 IU/L) given her menopausal state. Although a pregnancy or a malignancy was unlikely on the basis of stable hCG levels, elevated gonadotrophins and a negative transvaginal ultrasound, her physicians were uncertain and chose an expectant approach by repeated testing. Ultimately, after consulting the laboratory, analytical interference was ruled out and pituitary origin of unusual high hCG level could be confirmed after conduction of a suppression test by oestrogen–progesterone hormone replacement therapy. Until that time, the patient had undergone a vast amount of laboratory tests and gynaecology consultations, resulting in an enormous amount of confusion, anxiety and overdiagnosis.

  • menopause (including Hrt)
  • pregnancy
  • pituitary disorders
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Footnotes

  • Patient consent for publication Obtained.

  • Contributors AYD: responsible for the laboratory analysis of blood and urine samples of the patient; wrote the first draft of the manuscript. REAM: edited the manuscript. WAS and JMD: principle gynaecologists of the patient, who took care for her. All authors: reviewed and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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