Daiter E, Braunstein G D, Snyder P J, Coutifaris C, Mastroianni L, Pavlou S N, Strauss J F
Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia 19104-6142.
J Clin Endocrinol Metab. 1994 Jun;78(6):1293-7. doi: 10.1210/jcem.78.6.8200928.
We report the evaluation of a 46-yr-old asymptomatic menopausal woman whose serum hCG concentrations remained persistently supra-normal for 3 yr (mean +/- SD, 20 +/- 10 IU/L; n = 19). Holo-hCG and beta-core fragments were detected in the patient's urine by Ultragel chromatography, followed by specific RIAs. Trophoblastic, germ cell, and other malignancies appeared to be excluded by the absence of serum tumor markers and imaging procedures of the pelvis, abdomen, breast, and chest. Administration of a single bolus dose of synthetic GnRH (100 micrograms) increased the serum hCG concentration by 50% (from 26 to 40 IU/L). Administration of the Nal-Glu GnRH antagonist (5 mg, sc, every 12 h for 1 week) decreased the serum hCG concentration from 27 to 4.6 IU/L. The pronounced decrease in the serum hCG concentration during antagonism of the action of endogenous GnRH by administration of Nal-Glu GnRH suggests that the pituitary is the source of the supra-normal serum hCG concentrations, because the pituitary is exposed to the highest concentration of endogenous GnRH.
我们报告了对一名46岁无症状绝经后女性的评估，其血清hCG浓度持续高于正常水平达3年（平均值±标准差，20±10 IU/L；n = 19）。通过超凝胶色谱法在患者尿液中检测到全hCG和β-核心片段，随后进行特异性放射免疫分析。由于血清肿瘤标志物阴性以及骨盆、腹部、乳房和胸部的影像学检查结果，排除了滋养层细胞、生殖细胞及其他恶性肿瘤。单次静脉注射合成GnRH（100微克）使血清hCG浓度升高了50%（从26 IU/L升至40 IU/L）。给予Nal-Glu GnRH拮抗剂（5毫克，皮下注射，每12小时一次，共1周）使血清hCG浓度从27 IU/L降至4.6 IU/L。通过给予Nal-Glu GnRH拮抗内源性GnRH的作用期间血清hCG浓度显著下降，提示垂体是血清hCG浓度高于正常水平的来源，因为垂体暴露于最高浓度的内源性GnRH。
