Estrogen production as a tumor marker in patients with gonadotropin-producing neoplasms

Urinary estradiol production rates, plasma estradiol, and peripheral conversion of dehydroepiandrosterone sulfate (DHEAS) to estradiol were explored in patients whose neoplasms made human chorionic gonadotropin and/or human chorionic gonadotropin beta fragments. In five men with choriocarcinoma, estradiol production was elevated, plasma estradiol was high, and DHEAS conversion to estradiol ranged from 0.5 to 11.7%. In six patients with "ectopic" gonadotropin-producing tumors, originating from lung, stomach, and liver, estradiol production was elevated to a lesser degree. Sera from 154 of 864 patients (16.8%) with a wide variety of advanced neoplastic disorders were noted to have minimal elevations of human chorionic gonadotropin beta subunit in their sera but had normal luteinizing hormone assays. Plasma estradiol levels in these patients were not elevated, and in only one of ten patients studied was there slight elevation of the estradiol production rate. Similarly, in only one of ten patients was there measurable conversion of DHEAS to estradiol. We conclude that, in patients whose neoplastic disorders are associated with major elevations of human chorionic gonadotropin, there is concordant extragonadal production of estradiol via DHEAS, presumably representing an associated trophoblastic function. However, estrogen production is not a sensitive tumor marker in those patients whose neoplasms are associated with minimal elevations of human chorionic gonadotropin beta fragments only.