Demir Ayşe Y, Musson Ruben Ea, Schöls Willem A, Duk Jitze M
Laboratory for Clinical Chemistry and Haematology, Meander Medical Center, Amersfoort, The Netherlands.
Laboratory for Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
BMJ Case Rep. 2019 Jan 3;12(1):e227203. doi: 10.1136/bcr-2018-227203.
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.
尽管一小部分围绝经期和绝经后女性除了促性腺激素水平升高外，人绒毛膜促性腺激素（hCG）浓度也有轻度升高（<14 IU/L），但相当多的临床医生并不知晓这一现象。我们报告一例53岁处于绝经状态的女性，其hCG浓度异常高（>40 IU/L）。尽管基于hCG水平稳定、促性腺激素升高及经阴道超声检查阴性，怀孕或恶性肿瘤的可能性不大，但她的医生仍不确定，选择通过反复检测采取观察等待的方法。最终，在咨询实验室后，排除了分析干扰，并在进行雌激素 - 孕激素激素替代疗法抑制试验后，证实异常高的hCG水平源于垂体。在此之前，患者接受了大量的实验室检查和妇科会诊，导致了极大的困惑、焦虑和过度诊断。
