Management and outcome of healthy women with a persistently elevated β-hCG

Purpose.Raised serum beta human chorionic gonadotrophin (β-hCG) not due to pregnancy can occur as a consequence of (1) gestational trophoblastic neoplasia (GTN), (2) non-gestational trophoblastic tumours, (3) a false-positive β-hCG, (4) the menopause or (5) a high normal level. Accurate differentiation between these causes is vital to avoid potentially inappropriate investigations and therapies, which may induce infertility or other serious adverse events. Here we report the United Kingdom experience of patients with an elevated β-hCG of initial uncertain cause and provide a clinical algorithm for the management of such cases.Method.The Charing Cross and Weston Park Hospital GTN databases were screened to identify patients referred with an elevated β-hCG who were not pregnant and had no previous diagnosis of GTN.Results.Between 1981 and 2004 fourteen women presented with persistently raised serum β-hCG resulting in diagnostic problems. False-positive β-hCG was excluded in all. Three patients developed gestational choriocarcinoma after 9–29 months. However, in 11 women no cause for the persistently elevated β-hCG was found. One of these achieved chemotherapy-induced normalisation of serum β-hCG, but the remaining 10 underwent surgery and/or chemotherapy without benefit. Thus, 71% (10/14) of patients remain well with unexplained elevated β-hCG levels.Conclusion.Elevated serum and urinary β-hCG levels in healthy women should be investigated systematically to exclude an underlying malignant process and to avoid inappropriate surgical and medical intervention. Long-term follow-up is required as tumours may not become apparent for many months or years.