Background: The normal pituitary production of human chorionic gonadotropin (hCG) alongside luteinizing hormone, and its presence in women after bilateral oophorectomy, during perimenopause and menopause, as measured in serum and urine, has been known for 30 years and is described in numerous publications. Last year our group discussed this finding in a correspondence to the editor in the March 15th issue of New England Journal of Medicine, yet the misinterpretation of low-level hCG in these women seems to have increased in magnitude.
Methods: This is an outcomes study of 36 cases of menopausal hCG referred to the USA hCG Reference Service over a 1-year period, from March 2007 to March 2008.
Results: Eight cases occurred in women after oophorectomy, 28 were women in menopause/perimenopause. Surgery was postponed in 5 (14%) of 36 cases, and in 3 cases (8%), chemotherapy was unnecessarily administered. In 2 cases, computed tomography scans were cancelled. The average hCG detected was 10 ± 7.2 IU/L in cases receiving an oophorectomy and 9.8 ± 6.7 in perimenopause and 11 ± 6.2 IU/L in menopause cases.
Conclusions: Low-level hCG production in woman in physiologic perimenopause, in menopause, or in women with prior bilateral oophorectomy is a normal biologic and biochemical phenomenon. Management protocols in all fields need to be changed to accept pituitary hCG as normal and recognize the clinical maneuvers that will secure the diagnosis. Understanding this physiology will avoid needless delays in necessary therapies such as organ transplant procedures and will limit the misadventure of prescribing unnecessary cancer treatments.
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