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 Ongoing low hCG levels in 23 yr. female  



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Author6 Posts
  #1

1. 23 year old female presents with ongoing low levels of hCG. Weekly B-hCG and urinalysis done for 16 months. hCG started at a level of 5 and slowly, for the past 16 months, the hCG level has risen to 15. Patient continues to menstruate.

2. Vaginal and abdominal ultra-sound are done. Nothing is found.

3. Blood tests for hormone levels are done. (FSH, LH..) All normal.

4. Methotrexate is given in one dose. hCG continues to rise.

5. Chest x-ray is normal. Pelvis and abdominal CT scan is done. Normal.

6. Patient undergoes a laparoscopy, hysteroscopy, and D&C. Normal.

7. Menstruation now lasts up to 3 weeks. Black/brown vaginal bleeding. Birth control is attempted during the last 16 months and the patient bleeds vaginally throughout the whole time she takes the pill. Different brands are tried.

8. Patient for the last 3 months now has severe abdominal pain. STD and other tests (UTI, bladder) are performed. All normal.

9. Patient for the past month now has sticky, yellowish/brown discharge coming from her right breast.

10. Not too sure where to go from here. Frustrating for me, as well as patient. Any help from anyone would be greatly appreciated. What tests could be done next?




  #2

Hi Frilla
Last few days i was watching here and wondering if anyone going to say something about your question and your case and curious about what is going to happen... the story sounds really bizarre :|
you have already did lots of research about it..but i read something that multiple forms of hCG (intact hCG, nicked hCG, hyperglycosylated or carbohydrate-variant hCG, asialo hCG, free ß-subunit or ß-core fragment)may arise from different origins of the hCG-related molecules (pregnancy, pituitary hCG, hydatidiform mole, persistent trophoblast disease, choriocarcinoma, germ cell or other cancer, phantom or false-positive hCG) ...i think you have already eliminated lots of them with your former work...
i am not sure about that but maybe further search would be specific subtypes of hcg to figure out its origin...( :arrow: Germ cell, bladder and other non-trophoblastic malignancies.... :arrow: No pregnancy, no cancer, no evidence of disease, pituitary hCG production... :arrow: No pregnancy, no cancer, no evidence of disease, phantom or false positive hCG production... :?: )
i am really curious about whats going to happen ...if you have time i would be glad to hearing from you about the case...
good luck


  #3

Thanks for responding. I was waiting for anyone that might have an idea, but this is obviously a very rare case of something...

Patient went for an appointment with another doctor who specializes in hormones. The doctor did an internal examination and felt that the lower, left pelvic area was tender, and the patient was in pain. Doctor said the area felt cystic. She has ordered a Barium Enema and an ultra-sound and a battery of tests that weren't done before.

So, as I follow this patient, I wonder. The doctor I conferred with said perhaps it's not a GYN problem, but perhaps a lower GI problem. We'll hopefully find out soon. I'm starting to think this patient perhaps has colon cancer, which carries an hCG value, but I don't want to jump ahead, so I'll wait for the test results first and see! Thanks, F.


  #4

Hi Frilla
Thanks for explanation of recent examinations and findings ,i hope you 'll find out whats going on very soon...i am curious about further test results and diagnosis to be,too..if you have time i'll be glad to hearing what happened,good luck


  #5

HI!

I am just wandering whether arepeated abd. US would be useful. For me this case resembles an ectopic pregnancy.


  #6

Hey there!

Actually, the patient has had several U/S. The last one being a few weeks ago and another scheduled in January.

We've just sent her for an MRI of her head and are now waiting for the results of that and several other blood tests.

The doctor I am working under has been doing b-hCG assays and they are all positive. The patients levels are slowly rising... I question what will happen next. I don't want my patient to end up severely ill. I also wanted to mention that the patient has been crashing mentally, and it's hard not to have answers for her.

I have to admit that working in this feild has been exciting, as well as frustrating.





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