Case Report

Amenorrhea and pituitary human chorionic gonadotrophin production in a 38-year-old presenting as pregnancy of unknown location: case report and review of literature

Authors: Theadora Ordog (University of Iowa Carver College of Medicine, Iowa City, Iowa) , Marika Rebecca Raff (University of Iowa Carver College of Medicine, Iowa City, Iowa) , Mary B. Rysavy (University of Iowa Carver College of Medicine, Iowa City, Iowa) , Eyup Hakan Duran (University of Iowa Carver College of Medicine, Iowa City, Iowa) , James R. Scott (University of Iowa Carver College of Medicine, Iowa City, Iowa) , Abey Eapen (University of Iowa Carver College of Medicine, Iowa City, Iowa)

  • Amenorrhea and pituitary human chorionic gonadotrophin production in a 38-year-old presenting as pregnancy of unknown location: case report and review of literature

    Case Report

    Amenorrhea and pituitary human chorionic gonadotrophin production in a 38-year-old presenting as pregnancy of unknown location: case report and review of literature

    Authors: , , , , ,

Abstract

Background: Amenorrhea and extraplacental production of serum human chorionic gonadotropin (hCG), particularly in young women, can mimic a pregnancy of unknown location. Elevated serum hCG in the absence of pregnancy can pose a diagnostic dilemma and has led to potentially harmful and unwarranted interventions including chemotherapeutic agents like methotrexate or have led to delay in necessary medical interventions in women.

We report a case to demonstrate that amenorrhea and extraplacental human chorionic gonadotropin (hCG) production in young women can mimic a pregnancy of unknown location. Furthermore, we performed a critical review of literature on pituitary hCG production.

Case: A 38-year-old woman with a diagnosis of Silver-Russell syndrome, a unicornuate uterus, history of right oophorectomy for a benign serous cystadenoma and a desire for pregnancy presenting with a provisional diagnosis of pregnancy of unknown location.After performing a thorough review of history, physical examination, ultrasound exams, and a review of hormone analysis [including hCG, Tumor markers, Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Anti-Mullerian Hormone (AMH), Estradiol (E2) levels], we confirmed the diagnosis of premature ovarian insufficiency and pituitary hCG production.

Conclusions: In women, serum levels of hCG may increase with age, and are not always an indicator of pregnancy. Therefore, it is imperative to interpret false-positive test results and rule out the extraplacental production of hCG. This will help prevent unnecessary surgical procedures and treatment, including chemotherapy.

Keywords: Amenorrhea, pregnancy of unknown location, methotrexate, pituitary hCG, premature ovarian failure

How to Cite: Ordog T, Raff MR, Rysavy MB, Duran EH, Scott JR, Eapen A. Amenorrhea and pituitary human chorionic gonadotrophin production in a 38-year-old presenting as pregnancy of unknown location: case report and review of literature. Proc Obstet Gynecol. 2022;11(1):Article 3 [ 11 p.]. Available from: https://pubs.lib.uiowa.edu. Free full text article.

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Published on
11 Feb 2022
Peer Reviewed
License
CC BY 4.0