Falsely elevated human chorionic gonadotropin leading to unnecessary therapy1

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Abstract
BACKGROUND: Analysis of serum β-hCG aids diagnosis and treatment of intrauterine pregnancies, ectopic gestations, and gestational trophoblastic neoplasia. β-hCG concentrations are specific for trophoblastic tissue, thus are rarely questioned. CASES: An 18-year-old nullipara had bleeding and a positive β-hCG. Ultrasound identified no pregnancy. She passed tissue and stopped bleeding. Serum β-hCG remained elevated despite uterine curettage and three courses of methotrexate. Results of urine β-hCG were negative, as was reference laboratory serum assay. A 31-year-old nullipara had a spontaneous abortion, but serum β-hCG remained elevated. Uterine curettage found secretory endometrium, yet elevated serum β-hCG persisted. Urine β-hCG was negative, as was reference laboratory serum assay. CONCLUSION: Patients with histories incongruent with serum β-hCG findings should have urine β-hCG analysis.

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