PathWays Case Study: June 16

A 51-year-old postmenopausal woman taking ethinyl estradiol/levonorgestrel presented to her obstetrician/gynecologist with irregular vaginal bleeding. As a part of the routine work-up, a serum beta human chorionic gonadotropin (β-hCG) concentration was measured at 28,725 IU/L. A repeat serum β-hCG value four days later was 29,592 IU/L, while an elevated β-hCG concentration was also detected in the patient's urine.

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Brooke Katzman, Ph.D.

Brooke Katzman, Ph.D.
Fellow, Clinical Chemistry
Mayo Clinic

 

 

 

Nikola Baumann, Ph.D.

Nikola Baumann, Ph.D.
Consultant, Division of Clinical Core Laboratory Services
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

apriljosselyn

April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.

Responses

Correct diagnosis.

bi-manual pelvic vaginal exam to note size of uterus; is it soft or firm; fetal tones present; any nausea or vomiting; ultrasound which can note ‘starburst” pattern within uterus.
Possible Cushing’s Syndrome; diagnostic studies with a urinary 24-hour cortisol suppression test with dexamethasone; AM & PM plasma cortisol; CT of abdomen to visualize the adrenals.
stop hormone therapy and do weekly hCG test to see if values drop. Discussion between pathologist and provider to ensure there is not a misdiagnosis and treatment when these antibodies may be interfering and giving false positives for a pregnancy.
In light of all this may need a hysterectomy with appropriate referral.

I believe it’s a true fact due to hormones can really never b controlled unless every thing isrremoved.

Cardio cases or any. CASES

Cardio cases or any. Medicin is very good

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