A rational diagnostic approach to the “phantom hCG” and other clinical scenarios in which a patient is thought to be pregnant but is not

Oyatogun, Oluwafunmilayo; Sandhu, Mandeep Kaur; Barata-Kirby, Stephanie; Tuller, Erin; Schust, Danny J.

doi:10.1177/26334941211016412

Cited by 5 publications

(5 citation statements)

References 65 publications

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“…How do we proceed if HAMA are suspected? Many authors have made recommendations on how to avoid an incorrect assessment of hCG levels (23)(24)(25)(26). The American College of Obstetricians and Gynecologists, Committee on Gynecologic Practice, has even issued an opinion that addresses this problem (27).…”

Section: Discussionmentioning

confidence: 99%

False positive result of human chorionic gonadotropin caused by human anti-mouse antibodies

Ráček

Potočová

Rajdl

et al. 2023

Biochem. med. (Online)

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Immunochemical reactions are fast, can be automated, and generally do not require pretreatment of biological material. Based on these advantages, they are widely used. On the other hand, they are susceptible to analytical interference that can lead to inaccurate results. These factors include the presence of anti-mouse antibodies, causing false positive (or sometimes false negative) results. Although the anti-mouse antibodies over many decades have been repeatedly identified to be the causative source but due to the rarity of such encounters they remain insufficiently considered. Here we show a case, a 45 year-old female who was mis-diagnosed with pregnancy due to falsely elevated human chorionic gonadotropin (hCG) due to anti-mouse antibodies. This led to the patient undergoing two ultrasound examinations and laparoscopy before the hCG was repeated on alternative assays which showed negative results, preventing the patient from methotrexate treatment. Here we describe the details of the case, outline the assay principal, supporting the finding from literature and outlining a process on how to identify such interferences in timely manner.

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Section: Discussionmentioning

confidence: 99%

False positive result of human chorionic gonadotropin caused by human anti-mouse antibodies

Ráček

Potočová

Rajdl

et al. 2023

Biochem. med. (Online)

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“…The increases are also related to the presence of heterophile antibodies in these patients [37]. Persistently high levels of hCG were reported in three patients diagnosed with Munchausen syndrome, but the results of serial hCG tests (in both serum and urine) were inconsistent: the levels fluctuated, rising and falling rapidly, which suggested an exogenous administration of recombinant hCG [38,39].…”

Section: Chorionic Gonadotropin (Hcg)mentioning

confidence: 93%

Factors influencing blood tumor marker concentrations in the absence of neoplasia

Trapé,

Fernández-Galán,

Auge

et al. 2024

TUB

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BACKGROUND: Tumor markers (TMs) are a heterogeneous group of molecules used in the diagnosis, prognosis and follow-up of cancer patients. During neoplastic differentiation, cells can either directly synthesize or induce the synthesis of TMs, and the release of these molecules into the bloodstream allows their quantification in biological fluids. Although very small concentrations of TMs are usually present in the serum or plasma of healthy subjects, increased concentrations may also be found in the presence of benign diseases or due to technical interference, producing false positive results. MATERIAL AND METHODS AND RESULTS: Our review analyses the causes of false positives described between January 1970 to February 2023 for the TMs most frequently used in clinical practice: α-fetoprotein (AFP), β2-microglobulin (β2-M), cancer antigen 15-3 (CA 15-3), cancer antigen CA 19-9 (CA 19-9), cancer antigen CA 72-4 (CA 72-4), cancer antigen 125 (CA 125), carcinoembryonic antigen (CEA), chromogranin A (CgA), choriogonadotropin (hCG), cytokeratin 19 fragment (CYFRA 21-1), neuron-specific enolase (NSE), human epididymis protein 4 (HE4), serum HER2 (sHER2), squamous cell carcinoma antigen (SCCA), protein induced by vitamin K absence-II (PIVKA-II), Pro-gastrin-releasing peptide (Pro-GRP), prostate-specific antigen (PSA), Protein S-100 (S-100) and thyroglobulin (Tg). A total of 247 references were included. CONCLUSIONS: A better understanding of pathophysiological processes and other conditions that affect the concentration of TMs might improve the interpretation of results and their clinical application.

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“…73 This can occur when hCG levels are truly elevated, but the patient is not pregnant, for example, patients with familial hCG syndrome 74 and patients with elevated levels of heterophilic antibodies directed against animal proteins (encountered in people working with animals). 75,76 Aberrant forms or degradation products of the hCG molecule, gestational trophoblastic disease, nontrophoblastic malignancy, pituitary-synthesized hCG, and recent exogenous administration of hCG can all cause falsepositive tests, [75][76][77][78][79] as can problems with test performance and quality of the assay.…”

Section: Human Chorionic Gonadotropinmentioning

confidence: 99%

Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review

Jackson,

Hunter,

Van Norman

2023

Anesthesia &Amp; Analgesia

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Respect for patient autonomy is a pillar of medical ethics, manifested predominantly through informed consent. Mandatory (routine) nonconsented preoperative urine pregnancy testing does not adequately respect patient autonomy, is potentially coercive, and has the potential to cause harm medically, psychologically, socially, and financially. Inaccuracies in pregnancy testing can result in false-positive and false-negative results, especially in early pregnancy. There is substantial scientific evidence that anesthesia is not harmful to the fetus, raising the question of whether pregnancy testing provides substantial benefit to the patient. Not performing a preanesthesia pregnancy test has not been associated with significant medicolegal consequences. We review the ethical implications of mandatory preanesthesia pregnancy testing in light of these facts.

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A rational diagnostic approach to the “phantom hCG” and other clinical scenarios in which a patient is thought to be pregnant but is not

Cited by 5 publications

References 65 publications

False positive result of human chorionic gonadotropin caused by human anti-mouse antibodies

False positive result of human chorionic gonadotropin caused by human anti-mouse antibodies

Factors influencing blood tumor marker concentrations in the absence of neoplasia

Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review

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