Increased Human Chorionic Gonadotropin Level in a Nonsexually Active Young Female

Area of Science:

• Neurology
• Oncology
• Emergency Medicine

Background:

• Quantitative and qualitative human chorionic gonadotropin (hCG) tests are standard in emergency departments to assess pregnancy in females of child-bearing age.
• Elevated hCG levels can be associated with conditions other than pregnancy, including tumors and endocrine disorders.
• Intracranial germ cell tumors, rare hCG-secreting central nervous system tumors, predominantly affect adolescent and young adult females.

Purpose of the Study:

• To highlight the importance of considering non-pregnancy related causes of elevated hCG in young females presenting with concerning symptoms.
• To emphasize the diagnostic challenges and management considerations for emergency physicians when faced with elevated hCG in the absence of confirmed pregnancy.

Main Methods:

• A case report detailing a 16-year-old female student presenting with headache, photophobia, phonophobia, nausea, and vomiting.
• Serum quantitative hCG was elevated, but transabdominal ultrasound was negative for intrauterine pregnancy.
• Brain imaging revealed an intracranial nongerminomatous germ cell tumor.

Main Results:

• The patient was diagnosed with an intracranial germ cell tumor.
• The diagnosis necessitated hospitalization and prompt initiation of chemotherapy.
• This case underscores that elevated hCG is not exclusively indicative of pregnancy, particularly in young patients with no sexual history.

Conclusions:

• Emergency physicians should maintain a high index of suspicion for malignancy when encountering elevated hCG levels in young females with negative pregnancy tests.
• Consultation with obstetrics and gynecology and pediatric oncology is crucial for comprehensive evaluation and management.
• Prompt diagnosis and initiation of treatment, such as chemotherapy, are vital for favorable outcomes in patients with intracranial germ cell tumors.