The secret of elevated β-HCG and LDH and HBDH in men

Preamble

HCG (humanchorionicgonadotropin), human chorionic gonadotropin, is a glycoprotein hormone secreted by the trophoblast cells of the placenta, composed of two subunits, α and β, a single subunit is not biologically active, and can only play a role
after forming dimers by non-covalent bonding.

HCG, as the most important marker for diagnosing women's early pregnancy, is widely used in clinical practice [1], and people think that checking HCG is to check whether a female patient is pregnant; HCG is not only an important diagnostic indicator of pregnancy, but also an important diagnostic index for choriocarcinoma and molar pregnancy, and in men, HCG is mainly used for the auxiliary diagnosis of testicular seminoma and also has high clinical value [2].

What are the causes and consequences of increased β-HCG and increased LDH and HBDH in men? Let's take a look at the case below
.

Case history

In the work of the laboratory department, the same thing is repeated every day: receiving samples, signing samples, centrifugation, on-machine testing samples, audit reports, etc.
, β-HCG testing is a relatively special testing item, with and without, meaning different meanings
.
I received a call from the doctor in the operating room and said: "Teacher, we are the operating room, urology, so-and-so patient, this patient needs blood transfusion"
.
"Okay, please send the transfusion request form and patient specimen to the blood transfusion department"
.

Put down the phone and immediately notify your colleagues
who attended the blood transfusion class that day.
20 minutes later, colleagues from the blood transfusion department to the biochemistry room to inform, the operating room called to inform that urology, a certain patient has stopped bleeding during surgery, the amount of bleeding is not much, so blood transfusion is not considered for the time being
.
Because I was curious about what kind of patient it was, I checked the patient's preoperative examination results in the LIS system, and the results were as follows:

Biochemical results before surgery:

Male tumor marker results before surgery:

Case studies

Check the medical records: the patient has developed left scrotal enlargement in May, no chills, fever, no urinary frequency, urgency, dysuria, fatigue after activity, left scrotal pain and mass continues to swell, weight loss of about 10kg in more than 20 days, no treatment outside, in order to seek further diagnosis and treatment, so he came to our hospital for treatment
.

Outpatient B ultrasound: a huge solid heterogeneous hypoechoic mass can be seen in the left scrotum, ranging from about 190mm×140mm×89mm (unreliable measurement), unclear boundaries, obvious uneven internal echo, CDFI: rich blood flow signal, Pv: can lead to high-speed high yang artery blood flow spectrum
.

CT examination of a huge mass in the left earthen area, about 15.
3 cm × 112 cm in size, with patchy low-altitude foci and calcified plaques inside, and the penis and right testicle were affected
.
Small nodular calcifications of
the prostate.
A small amount of fluid
in the scrotal area.
Abnormal bladder
ends.
Outpatient admission
.

Specialist examination: huge mass in the left scrotum, about 25 cm × 20 cm in size, solid, tender, with unclear
borders.
Negative
on the right side.

Male tumor marker results after surgery:

Biochemical results after surgery:

Pathological results:

Case summary

Many people think that β-HCG can only be detected in the body if she is pregnant, and that it is impossible for
men.
But this is not the case, both men and women, pregnant or not, secrete trace amounts of HCG
.
Germ cell tumors originate from embryonic pluripotent germ cells and are classified into germ cell tumors, teratomas, choriocytomas, embryonic carcinomas, endodermal sinus tumors or yolk sac tumors according to the WHO (2000) classification of central nervous system tumors [3].

Serum human chorionic gonadotropin (β-HCG) is mainly used clinically for (1) the diagnosis of normal pregnancy and the detection of pregnancy abnormalities; (2) diagnosis of ectopic pregnancy; (3) Auxiliary diagnosis and efficacy detection of trophoblast cell diseases; (4) Diagnosis and monitoring of testicular and ovarian germ cell tumors; (5) Assess the risk of Down syndrome (trisomy 21) [3].

What is the relationship between β-HCG and LDH and HBDH elevation: LDH and HBDH elevation are seen in myocardial infarction, lung injury, liver injury, skeletal muscle injury will be increased, especially hemolysis will also increase, nothing special
.

Check the relevant literature: In recent years, the role of LDH in solid tumors has gradually become a hot spot, caused by the metabolic mode
of tumor cells that are disconnected from the tricarboxylic acid cycle.
Sugar is the main source of energy for the human body, and there are two metabolic pathways of aerobic oxidation and anaerobic fermentation: the cleavage of one molecule of glucose into two molecules of pyruvate is their common first step, and then when the oxygen supply is sufficient, pyruvate enters the mitochondria to completely oxidize phosphorylation into CO2 and H2O; When the oxygen supply is insufficient or oxygen cannot be used, pyruvate is reduced to lactic acid in the cytosol (catalyzed by LDH!).
）
。

Red blood cells have no organelles, especially no mitochondria, and can only provide energy through anaerobic fermentation, sugar is produced by anaerobic fermentation to pyruvate, LDH catalyzes pyruvate into lactic acid, and lactic acid is released into the bloodstream to the liver and bioconverted into sugar [4].

Without LDH, pyruvate cannot be converted into lactic acid, pyruvate will accumulate, anaerobic fermentation cannot be carried out, and cells cannot survive
.
Tumor cells, especially highly metabolized tumor cells, even in the case of aerobic, these tumor cells like to provide energy in the way of anaerobic fermentation, anaerobic fermentation requires a large amount of LDH, these tumor cells grow fast, large amount, will release a large amount of LDH into the blood, LDH is elevated
.

α-Hydroxybutyrate dehydrogenase is actually the LDH activity measured when using α-ketobutyric acid as a substrate, which can basically represent the activity of LDH1 and LDH2, so it is often accompanied by LDH [5].

Through this case, it was learned that β-HCG can be used as a tumor marker for early diagnosis of germ cell tumors, lesion localization, and evaluation of efficacy to detect recurrence [6].

LDH is expected to become an effective prognostic marker and novel therapeutic target for malignant tumors [7].

The biochemical immunology room can carry out a large number of testing items, a number change, the meaning is different, in the process of work in time to understand the new clinical progress of each test item, in the work encountered problems, timely communication and communication with clinicians, to provide more help
for patients.

References

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

[2] You Xiaohui, Xue Min, Clinical features and ultrasound performance comparison of testicular seminoma and non-seminoma, Medical Information, 2020, 33(24)

[3] Shang Hong, Wang Yusan, et al.
, National Clinical Laboratory Operating Rules (Fourth Edition), People's Medical Publishing House

[4] Li Guixing, The story behind the test numbers (7) - the secret of simple LDH elevation

[5] Wang Yanpingdinghong, A new solution to the clinical significance of LDH

[6] Li Yanhong, Su Zhe et al.
, Clinical features of germ cell tumor in children with precocious puberty and the value of serum and cerebrospinal fluid β-HCG determination in tumor localization and diagnosis, Chinese Journal of Pediatrics[J]2010, 48(10): 771-774

[7] Ji Guishuang.
Application of serum lactate dehydrogenase and its isoenzyme detection in the diagnosis and treatment of ovarian cancer[J].
China Health and Nutrition,2019,29(9):360.
)