“Hook effect” in complete hydatidiform molar pregnancy: A falsely low level of β-hCG

Levavi, Hanoch; Neri, Alexander; J, Bar; Regev, D; Nordenberg, J; Ovadia, Jardena

doi:10.1097/00006250-199310000-00062

Cited by 16 publications

(14 citation statements)

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“…Above this concentration, the assay will record falsely lower results as the concentration rises higher. This can be corrected by dilution of a sample and this was exactly what we did in this case [8]. …”

Section: Discussionsupporting

confidence: 56%

Twin pregnancy with complete hydatidiform mole and coexisting fetus following ovulation induction with a non-prescribed clomiphene citrate regimen: a case report

et al. 2012

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IntroductionTwin pregnancy with complete hydatidiform mole represents a very rare obstetric problem. Management of such cases is always problematic because the possibility of fetal survival should always be weighed against the risk of complications of molar pregnancy.Case presentationA 34-year-old Caucasian woman presented to our center with mild vaginal bleeding. Our patient was 16 weeks pregnant after a seven-year period of primary infertility. She became pregnant following a non-prescribed regimen of clomiphene citrate extending from the second day to the 13th day of her last cycle. A transabdominal ultrasound examination revealed a twin pregnancy with complete hydatidiform mole and a coexisting fetus. Serum β human chorionic gonadotropin was falsely low as identified by serial dilution of the sample (the 'hook effect'). Our patient refused termination of pregnancy and she was hospitalized for strict observation and follow-up. Unfortunately, she developed an attack of severe vaginal bleeding and a hysterotomy was performed. The fetus died shortly after birth.ConclusionsTwin pregnancy with complete hydatidiform mole represents a matter of controversy. We suggest that conservation should always be considered whenever tertiary care services and strict observation are available.

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Section: Discussionsupporting

confidence: 56%

Twin pregnancy with complete hydatidiform mole and coexisting fetus following ovulation induction with a non-prescribed clomiphene citrate regimen: a case report

et al. 2012

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“…Serum and urinary hCG concentrations are indicative of pregnancy status and can be used to determine various conditions related to the pregnancy. Falsely low results could result in failure to diagnose or a slower diagnosis of these conditions 20 .…”

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confidence: 99%

Mitigating the Hook Effect in Lateral Flow Sandwich Immunoassays Using Real-Time Reaction Kinetics

et al. 2017

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The quantification of analyte concentrations using lateral flow assays is a low-cost and user-friendly alternative to traditional lab-based assays. However, sandwich-type immunoassays are often limited by the high-dose hook effect, which causes falsely low results when analytes are present in very high concentrations. In this paper, we present a reaction kinetics-based technique that solves this problem, significantly increasing the dynamic range of these devices. With the use of a traditional sandwich lateral flow immunoassay, a portable imaging device, and a mobile interface, we demonstrate the technique by quantifying C-reactive protein concentrations in human serum over a large portion of the physiological range. The technique could be applied to any hook effect-limited sandwich lateral flow assay and has a high level of accuracy even in the hook effect range.

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“…This high amount of the subunit can overwhelm the assay system and blocks the formation of ‘sandwiches’ between the two antibody–antigen sites. This phenomenon has been observed in several cases where β hCG is made in excess, such as molar pregnancy, multiple gestations or cancer 10 11. With our patient, the suspicion for an obstetrical related disorder was low, but given the uncommon report of an indeterminate urine assay, we followed our institution's laboratory recommendation of following up with a serum β hCG.…”

Section: Discussionmentioning

confidence: 79%

Molar pregnancy after tubal ligation in a patient with neuroendocrine tumour: when a rare condition coincides with an unexpected diagnosis

Semenya

Roberts²,

Mounsey

2014

BMJ Case Reports

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A 40-year-old woman with a history of bilateral tubal ligation and a recent diagnosis of metastatic neuroendocrine tumour in the liver presented with severe nausea, vomiting, diarrhoea and dehydration. She had an inconclusive urine pregnancy test in the emergency department that was followed by an extremely high serum β-human chorionic gonadotropin. Transvaginal ultrasound, MRI and subsequent pathology from a dilation and curettage (D&C) revealed that the patient had a complete molar pregnancy. This is a case of an unusual patient who reminds us that one person can have a rare diagnosis and an unexpected obstetrical outcome. We could find no evidence in the medical literature of a causal link between these two diagnoses but present this case report of a reproductive age woman with neuroendocrine tumour and complete molar pregnancy. This case also serves as an example of the phenomenon of the 'hook effect.'

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“Hook effect” in complete hydatidiform molar pregnancy: A falsely low level of β-hCG

Cited by 16 publications

References 0 publications

Twin pregnancy with complete hydatidiform mole and coexisting fetus following ovulation induction with a non-prescribed clomiphene citrate regimen: a case report

Twin pregnancy with complete hydatidiform mole and coexisting fetus following ovulation induction with a non-prescribed clomiphene citrate regimen: a case report

Mitigating the Hook Effect in Lateral Flow Sandwich Immunoassays Using Real-Time Reaction Kinetics

Molar pregnancy after tubal ligation in a patient with neuroendocrine tumour: when a rare condition coincides with an unexpected diagnosis

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