Increased Human Chorionic Gonadotropin Level in a Nonsexually Active Young Female.

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  • Author(s): Elder NM;Elder NM; McCormick A; McCormick A
  • Source:
    The Journal of emergency medicine [J Emerg Med] 2024 Dec; Vol. 67 (6), pp. e569-e571. Date of Electronic Publication: 2024 Aug 03.
  • Publication Type:
    Journal Article; Case Reports
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 8412174 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 0736-4679 (Print) Linking ISSN: 07364679 NLM ISO Abbreviation: J Emerg Med Subsets: MEDLINE
    • Publication Information:
      Publication: <2010>- : New York : Elsevier
      Original Publication: New York : Pergamon Press, c1983-
    • Subject Terms:
      Chorionic Gonadotropin*/blood; Humans ; Female ; Adolescent ; Brain Neoplasms/complications ; Brain Neoplasms/blood ; Brain Neoplasms/diagnosis ; Emergency Service, Hospital/organization & administration ; Neoplasms, Germ Cell and Embryonal/blood ; Neoplasms, Germ Cell and Embryonal/complications ; Neoplasms, Germ Cell and Embryonal/diagnosis ; Headache/etiology
    • Abstract:
      Background: Quantitative and qualitative human chorionic gonadotropin (hCG) tests are obtained in the emergency department (ED) to determine if a female of child-bearing age is pregnant. A positive hCG result is commonly assumed to indicate an intrauterine or other form of pregnancy. However, elevated hCG levels can also result from various other conditions, such as ovarian tumors, pituitary tumors, and thyroid disorders. Intracranial germ cell tumors, rare central nervous system tumors capable of secreting hCG, primarily affect adolescent and young adult females.
      Case Report: A 16-year-old female student without significant past medical history presented to our ED with a complaint of intermittent bilateral frontal headache for two days. Last menstrual period started two days prior to presentation. The headache was associated with phonophobia, photophobia, nausea, and vomiting. Serum quantitative hCG was elevated. She denied history of sexual activity or sexual assault. Transabdominal ultrasound was negative for intrauterine pregnancy. Obstetrics and gynecology as well as pediatric oncology were consulted. Subsequent investigations, including brain imaging, revealed a 3.5 cm mass in the right caudate nucleus and corpus callosum. The patient was diagnosed with an intracranial nongerminomatous germ cell tumor, necessitating hospitalization and prompt initiation of chemotherapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: An elevated quantitative hCG is not always indicative of pregnancy, especially in a young patient without sexual history. In the case of a nonrevealing transabdominal ultrasound, obstetrics and gynecology should be consulted for discussion of further testing and imaging. Emergency physicians should include malignancy high on their differential since prompt initiation of chemotherapy, evaluation by surgical services, and family planning will be required.
      Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
      (Copyright © 2024 Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: human chorionic gonadotropin; neuro-oncology; obgyn; oncology; pediatrics
    • Accession Number:
      0 (Chorionic Gonadotropin)
    • Publication Date:
      Date Created: 20240907 Date Completed: 20241211 Latest Revision: 20241211
    • Publication Date:
      20241212
    • Accession Number:
      10.1016/j.jemermed.2024.07.020
    • Accession Number:
      39244487