Increased hCG in older men! What's the situation?

preface

As the most important marker in the diagnosis of early pregnancy in women, hCG is widely used in clinical ^practice[1], and the gold standard method of early pregnancy test strips is also widely known^[2], so much so that it is believed that checking for hCG is to check whether a patient is pregnant
.

Case passed

The patient is male, 57 years old
.

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From March 2022 to the hospital to complete the left kidney puncture biopsy, March 2, 2022 disease investigation: (left kidney puncture tissue) a small amount of distribute in the kidney tissue scattered in the distribution of trace amounts of heterotypic epithelial components, considering epithelial malignant tumors, renal cell carcinoma is likely, it is recommended that intraoperative frozen examination to further assist in diagnosis
.

Table 1 Hormone level test results of patients

Patients with elevated E2, decreased T, and mildly elevated PRL, while a mild increase in serum β-HCG was found: 4.

Case studies

Inspection Case Study:

The patients were older men, but E2 was elevated, T was lower, PRL was mildly elevated, and the results were complex and could not be well explained
.

Looking at the relevant male hCG elevation data, it was found that the accompanying tumor secretion syndrome can lead to hCG increase, such as lung cancer and other tumors, HCG can secrete HCG, and serum hCG increase can inhibit FSH and LH, the occurrence of these 2 items are reduced, while HCG can stimulate E2 to increase, and elevated E2 can inhibit T levels
.

Clinical Case Studies:

The patient is an elderly male, 57 years old, his own condition is poor, he has a history of kidney cancer, but he has not undergone kidney tumor surgery, nor has he undergone orchiectomy, and the current patient has an elevated hCG, elevated E2, and decreased
T.

Knowledge development

In addition to the symptoms caused by the tumor itself and metastasis, some malignancies can also cause a variety of clinical manifestations through the production of hormones or hormone-like substances
.

Table 2 Brief description of endocrine syndrome with neoplasia

Case summary

Syndrome with tumor secretion is an important cause
of complex symptoms and signs in tumor patients.

Expert reviews

Professor Deng Zhiyong, Yunnan Provincial Cancer Hospital

Malignant tumors have not only abnormal manifestations of the primary lesion, but also abnormal symptoms and signs
caused by metastasis.

References:

[1] Xiaoling Hu, Qiu Ju β-HCG, P, Inhibin-A correlation between diagnosis and treatment of patients with ectopic pregnancy, Journal of Hunan Normal University (Medical Edition), 2022, 19(1)

[2] Fengrong He, Lingheng Zeng, Performance Evaluation of Two Colloidal Gold Test Strips for Detection of Serum Human Chorionic Gonadotropin, Chinese Medical Guidelines, 2020,18(34)

[3] Xiaohui You, Min Xue, Comparison of Clinical Features and Ultrasound Manifestations of Testicular Semineracytoma and Non-seminogenica Germ Cell Tumors, Medical Information, 2020, 33(24)

[4] Wang Jian, Jiang Xia, A case of lung carcinoid with Cushing syndrome as the first manifestation, Medical and Health Science and Technology, Oncology, 2010.