Elevated Human Chorionic Gonadotrophin Due to Pancreatic Cancer


Preoperative pregnancy testing is common practice among anesthesiologists. Little is re-ported in anesthesia literature on causes other than pregnancy for elevated human chorionic go-nadotrophin (hCG) levels. Among these causes is hCG secretion by tumors. This is a report of a female with pancreatic cancer that presented for a Whipple procedure, who on routine pregnancy testing was found to have an elevated hCG level. This unexpected result led to significant delay and undue stress for the patient. After determining pregnancy was unlikely and multiple poorly differentiated metastatic masses were discovered, it was decided that the most likely cause of her hCG levels was cancer. Multiple cancers have been reported to secrete hCG, and more specifically β hCG [1]. Studies of elevated hCG in pancreatic cancer patients report an incidence of 40% - 56% [2,3]. Serum β hCG testing done prior to the date of surgery (DOS) in cancer pa- tients that are pre- or perimenopausal should be considered as it would allow time for a more definitive pregnancy evaluation to be performed.

Share and Cite:

A. Manohar, E. Werner and J. Murphy, "Elevated Human Chorionic Gonadotrophin Due to Pancreatic Cancer," Open Journal of Anesthesiology, Vol. 2 No. 4, 2012, pp. 178-182. doi: 10.4236/ojanes.2012.24040.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] U. H. Stenman, H. Alfthan and K. Hotakainen, “Human Chorionic Gonadotropin in Cancer,” Clinical Biochemistry, Vol. 37, No. 7, 2004, pp. 549-561. doi:10.1016/j.clinbiochem.2004.05.008
[2] K. N. Syrigos, I. Fyssas, M. M. Konstandoulakis, K. J. Harrington, S. Papadopoulos, N. Milingos, P. Peveretos and B. C. Golematis, “Beta Human Chorionic Gonadotropin Concentrations in Serum of Patients with Pancreatic Adenocarcinoma,” Gut, Vol. 42, No. 1, 1998, pp. 8891. doi:10.1136/gut.42.1.88
[3] J. Louhimo, S. Nordling, H. Alfthan, K. von Buguslawski, U. H. Stenman and C. Haglund, “Specific Staining of Human Chorionic Gonadotropin Beta in Benign and Malignant Gastrointestinal Tissues with Monoclonal Antibodies,” Histopathology, Vol. 38, No. 5, 2001, pp. 418424. doi:10.1046/j.1365-2559.2001.01106.x
[4] Practice Advisory for Preanesthesia Evaluation, “An Updated Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation,” Anesthesiology, Vol. 116, No. 3, 2012, pp. 1-17.
[5] S. Manley, G. Kelaita, N. J. Joseph, M. R. Salem and H. J. Heyman, “Preoperative Pregnancy Testing in Ambulatory Surgery,” Anesthesiology, Vol. 83, No. 4, 1995, pp. 690693. doi:10.1097/00000542-199510000-00007
[6] R. S. Twersky and G. Singleton, “Preoperative Pregnancy testing: ‘Justice and Testing for all’,” Anesthesia & Analgesia, Vol. 83, No. 2, 1996, pp. 438-439. doi:10.1213/00000539-199608000-00059
[7] M. Wheeler and C. J. Cote, “Preoperative Pregnancy testing in a Tertiary Care Children’s Hospital: A MedicoLegal Conundrum,” Journal of Clinical Anesthesia, Vol. 11, No. 1, 1999, pp. 56-63. doi:10.1016/S0952-8180(98)00136-6
[8] R. L. Kahn, M. A. Stanton, S. Tong-Ngork, G. A. Liguori, C. R. Edmonds and D. S. Levine, “One-Year Experience with Day-of-Surgery Pregnancy Testing before Elective Orthopedic Procedures,” Anesthesia & Analgesia, Vol. 106, No. 4, 2008, pp. 1127-1131. doi:10.1213/ane.0b013e31816788df
[9] J. Louhimo, P. Finne, H. Alfthan, U. H. Stenman and C. Haglund, “Combination of HCG Beta, CA 19-9 and CEA with Logistic Regression Improves Accuracy in Gastrointestinal Malignancies,” Anticancer Research, Vol. 22, No. 3, 2002, pp. 1759-1764.
[10] S. Birken, G. Kovalevskaya and J. O’Connor, “Immunochemical Measurement of Early Pregnancy Isoforms of HCG: Potential Applications to Fertility Research, Prenatal Diagnosis, and Cancer,” Archives of Medical Research, Vol. 32, No. 6, 2001, pp. 635-643. doi:10.1016/S0188-4409(01)00329-0
[11] D. Bellet, V. Lazar and I. Bieche, “Malignant Transformation of Nontrophoblastic Cells is Associated with the Expression of Chorionic Gonadotropin Beta Genes Normally Transcribed in Trophoblastic Cells,” Cancer Research, Vol. 57, No. 3, 1997, pp. 516-23.
[12] H. Alfthan, C. Haglund, P. Roberts and U. H. Stenman, “Elevation of Free Beta Subunit of Human Choriogonadotropin and a Core Beta Fragment of Human Choriogonadotropin in the Serum and Urine of Patients with Malignant Pancreatic and Biliary Disease,” Cancer Research, Vol. 52, No. 17, 1992, pp. 4628-33.
[13] U. H. Stenman, L. Unkila-Kallio, J. Korhonen and H. Alfthan, “Immunoprocedures for Detecting Human Chorionic Gonadotropin: Clinical Aspects and Doping Control,” Clinical Chemistry, Vol. 43, No. 3, 1997, pp. 12931298.
[14] L. A. Cole, “Hyperglycosylated hCG, a Review,” Placenta, Vol. 31, No. 8, 2010, pp. 653-664. doi:10.1016/j.placenta.2010.06.005
[15] L. A. Cole and S. Butler, “Hyperglycosylated hCG, hCGβ and Hyperglycosylated hCGβ: Interchangeable Cancer Promoters,” Molecular and Cellular Endocrinology, Vol. 349, No. 2, 2012, pp. 232-238. doi:10.1016/j.mce.2011.10.029
[16] L. A. Cole, S. A. Butler, S. A. Khanlian, A. Giddings, C. Y. Muller, M. J. Seckl and E. I. Kohorn, “Gestational Trophoblastic Diseases: 2. Hyperglycosylated hCG as a Reliable Marker of Active Neoplasia,” Gynecologic Oncology, Vol. 102 No. 2, 2006, pp. 151-159. doi:10.1016/j.ygyno.2005.12.045
[17] D. L. Matthies and E. Diczfalusy, “Relationships between Physico-Chemical, Immunological and Biological Properties of Human Chorionic Gonadotrophin. I. Properties of Human Chorionic Gonadotrophin as Found in Tissues and Body Fluids,” Acta Endocrinology, Vol. 67, No. 3, 1971, pp. 434-444.
[18] P.D. Papapetrou, N.P. Sakarelou, H. Braouzi and P. Fessas, “Ectopic Production of Human Chorionic Gonadotropin (hCG) by Neoplasms: The Value of Measurements of Immunoreactive hCG in the Urine as a Screening Procedure,” Cancer, Vol. 45, No. 10, 1980, pp. 5832592. doi:10.1002/1097-0142(19800515)45:10<2583::AID-CNCR2820451018>3.0.CO;2-W
[19] S. Strickland and W. G. Richards, “Invasion of the Trophoblast Cell,” Cell, Vol. 71, 1992, pp. 355-357. doi:10.1016/0092-8674(92)90503-5
[20] R. O. Hussa, “The Clinical Marker hCG,” Praeger, New York, 1987.
[21] A. S. Duffield, P. Jarrar, C. Shum, N. Ahuja, C. J. Yeo and L. J. Sokoll, “Retroperitoneal Masses with Associated Human Chorionic Gonadotropin Production: Report of Two Cases,” Clinica Chimica Acta, Vol. 395, No. 1-2, 2008, pp. 166-169. doi:10.1016/j.cca.2008.04.030
[22] S. Hoshi, K. Suzuki, S. Ishidoya, C. Ohyama, M. Sato, T. Namima, S. Saito and S. Orikasa, “Significance of Simultaneous Determination of Serum Human Chorionic Gonadotropin (hCG) and hCG-Beta in Testicular Tumor Patients,” International Journal of Urology, Vol. 7, No. 6, 2007, pp. 218-223. doi:10.1046/j.1442-2042.2000.00181.x
[23] I. Marcillac, F. Troalen, J. M. Bidart, P. Ghillani, V. Ribrag, B. Escudier, B. Malassagne, J. P. Dorz, C. Lhomme, P. Rougier, et al., “Free Human Chorionic Gonadotropin beta Subunit in Gonadal and Nongonadal Neoplasms,” Cancer Research, Vol. 52, No. 14, 1992, pp. 3901-3907.
[24] C. Y. Muller and L. A. Cole, “The Quagmire of hCG and hCG Testing in Gynecologic Oncology,” Gynecologic Oncology, Vol. 112, No. 3, 2009, pp. 663-672. doi:10.1016/j.ygyno.2008.09.030
[25] G. D. Braunstein, J. L. Vaitukaitis, P. P. Carbone and G. T. Ross, “Ectopic Production of Human Chorionic Gonadotrophin by Neoplasms,” Annals of Internal Medicine, Vol. 78, No. 1, 1973, pp. 39-45.
[26] M. Lundin, S. Nordling, J. Lundin, H. Alfthan, U. H. Stenman and C. Haglund, “Tissue Expression of Human Chorionic Gonadotropin Beta Predicts Outcome in Colorectal Cancer: A Comparison with Serum Expression,” International Journal of Cancer, Vol. 95, No. 1, 2001, pp. 18-22. doi:10.1002/1097-0215(20010120)95:1<18::AID-IJC1003>3.0.CO;2-5
[27] K. Hotakainen, B. Ljungberg, A. Paju, T. Rasmuson, H. Alfthan and U. H. Stenman, “The Free Beta-Subunit of Human Chorionic Gonadotropin as a Prognostic Factor in Renal Cell Carcinoma,” British Journal of Cancer, Vol. 86, No. 2, 2002, pp. 185-189. doi:10.1038/sj.bjc.6600050
[28] V. M. Shah, J. Newman, J. Crocker, G. N. Antonakopoulos, C. R. Chapple and M. J. Collard, “Production of Beta-Human Chorionic Gonadotropin by Prostatic Adenocarcinoma and Transitional Cell Carcinoma of the Upper Urinary Tract,” British Journal of Experimental Pathology, Vol. 68, No. 6, 1987, pp. 871-878.
[29] D. C. Tormey, T. P. Waalkes and R. M. Simon, “Biological Markers in Breast Carcinoma. II. Clinical Correlations with Human Chorionic Gonadotrophin,” Cancer, Vol. 39, No. 6, 1997, pp. 2391-2396. doi:10.1002/1097-0142(197706)39:6<2391::AID-CNCR2820390613>3.0.CO;2-7
[30] J. Hedstrom, R. Grenman, H. Ramsay, P. Finne, J. Lundin, C. Haglund, H. Alfthan and U. H. Stenman, “Concentration of Free hCG Beta Subunit in Serum as a Prognostic Marker for Squamous-Cell Carcinoma of the Oral Cavity and Oropharynx,” International Journal of Cancer, Vol. 84, No. 5, 1999, pp. 525-528. doi:10.1002/(SICI)1097-0215(19991022)84:5<525::AID-IJC14>3.0.CO;2-Q
[31] R. W. Burt, J. G. Ratcliffe, B. H. Stack, J. Cuthbert, R. S. Kennedy, C. S. Corker, P. Franchimont, W. G. Spilg and W. H. Stimson, “Serum Biochemical Markers in Lung Cancer,” British Journal of Cancer, Vol. 37, 1978, pp. 714-717. doi:10.1038/bjc.1978.108
[32] M. Szturmowicz, E. Wiatr, A. Sakowicz, J. Slodkowska, K. Roszkowski, S. Filipecki and E. Rowinska-Zakrewska, “The Role of Human Chorionic Gonadotropin Beta Subunit Elevation in Small-Cell Lung Cancer Patients,” Journal of Cancer Research and Clinical Oncology, Vol. 121, No. 5, 1995, pp. 309-312. doi:10.1007/BF01209599
[33] M. Szturmowicz, J. Slodkowska, J. Zych, P. Rudzinski, A. Sakowicz and E. Rowinska-Zakrzewska, “Frequency and Clinical Significance of Beta-Subunit Human Chorionic Gonadotropin Expression in Non-Small Cell Lung Cancer Patients,” Tumour Biology, Vol. 20, No. 2, 1999, pp. 99104. doi:10.1159/000030052
[34] C. Palmieri, T. Dhillon, R. A. Fisher, A.-M. Yound, D. Short, H. Mitchell, C. Aghajanian, P. M. Savage, E. S. Newlands, B. W. Hancock and M. J. Seckl, “Management and Outcome of Healthy Women with a Persistently Increased Beta-hCG,” Gynecologic Oncology, Vol. 106, 2007, pp. 35-43. doi:10.1016/j.ygyno.2007.01.053
[35] U. H. Stenman, H. Alfthan, T. Ranta, E. Vartiainen, J. Jalkanen and M. Sepp?l?, “Serum levels of Human Chorionic Gonadotropin in Nonpregnant Women and Men Are Modulated by Gonadotropin-Releasing Hormone and Sex Steroids,” The Journal of Clinical Endocrinology & Metabolism, Vol. 64, No. 4, 1987, pp. 730736. doi:10.1210/jcem-64-4-730
[36] E. Daiter, G. D. Braunstein, P. J. Snyder, C. Coutifaris, L. Mastroianni, S. N. Pavlou and J. F. Strauss, “Gonadotropin-Releasing Hormone-Dependent Chorionic Gonadotropin Secretion in a Menopausal Woman,” The Journal of Clinical Endocrinology & Metabolism, Vol. 78, No. 6, 1994, pp. 1293-1297. doi:10.1210/jc.78.6.1293
[37] L. A. Cole, Y. Sasaki and C. Y. Muller, “Normal Production of Human Chorionic Gonadotropin in Menopause,” New England Journal of Medicine, Vol. 356, No. 11, 2007, pp. 1184-1186. doi:10.1056/NEJMc066500
[38] L. A. Cole, S. A. Khanlian, C. Y. Muller, A. Giddings, E. I. Kohorn and R. Berkowitz, “Gestational Trophoblastic Diseases. 3. Human Chorionic Gonadotropin-Free β-Subunit, a Reliable Marker of Placental Site Trophoblastic Tumors,” Gynecologic Oncology, Vol. 102, No. 2, 2006, pp. 160-164. doi:10.1016/j.ygyno.2005.12.046
[39] P. D. Papapetrou and N. I. Anagnostopoulos, “A Gonadotropin and Alpha-Subunit Suppression Test for the Assessment of the Ectopic Production of Human Chorionic Gonadotropin and Its Subunits after the Menopause,” The Journal of Clinical Endocrinology & Metabolism, Vol. 60, No. 6, 1985, pp. 1187-1195. doi:10.1210/jcem-60-6-1187
[40] W. J. Catalona, J. L. Vaitukaitis and W. R. Fair, “Falsely positive Specific Human Chorionic Gonadotropin Assays in Patients with Testicular Tumors: Conversion to Negative with Testosterone Administration,” Journal of Urology, Vol. 122, No. 1, 1979, pp. 126-128.
[41] D. A. Nyberg, R. A. Filly, B. S. Mahony, S. Monroe, F. C. Laing and R. B. Jeffrey, “Early Gestation: Correlation of HCG Levels and Sonographic Identification,” American Journal of Roentgenology, Vol. 144, No. 5, 1985, pp. 951-954
[42] K. D. Bagshawe, “Choriocarcinoma. A Model for Tumour Markers,” Acta Oncology, Vol. 31, 1992, pp. 99106. doi:10.3109/02841869209088275
[43] T. Chard, “Pregnancy Tests: A Review,” Human Reproduction, Vol. 7, No. 5, 1992, pp. 701-710.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.