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Human chorionic gonadotropin measurements in parathyroid carcinoma

M Rubin, Medicine, Columbia University College of Physicians & Surgeons, NY, United States
J Bilezikian, Columbia University College of Physician & Surgeons, Department of Medicine and Pharmacology, New York, United States
S Birken, New York, United States
S Silverberg, New York, United States

Correspondence: Mishaela Rubin, Email: mrr6{at}columbia.edu

Abstract

Objective: Preoperatively, it is difficult to differentiate between parathyroid cancer (PtCa) and severe primary hyperparathyroidism (PHPT) due to a benign tumor. Human chorionic gonadotropin (hCG) is a tumor marker in trophoblastic and nontrophoblastic cancers and hyperglycosolated hCG is increased in hCG-secreting malignancies. We investigated whether hCG can distinguish PtCa cancer from benign disease and add prognostic information.

Design: Observational study

Methods: Measurement of urinary hCG (total and malignant isoforms) and serum malignant hCG in 8 subjects with PtCa and in 18 subjects with PHPT (measurement of urine in 10 and of serum in 8).

Results: Total urinary hCG was normal in the benign PHPT control subjects (range: 0-17 fmol/mg Cr; nl< 50). In the PtCa subjects, 3 had normal total urinary hCG levels and survived complication-free for at least 2 years; 3 had persistently elevated total urinary hCG levels (range: 217-1986 fmol/mg Cr) and sustained hip fracture (n=3) and died (n=2) within 3 and 6 months, respectively; 2 had a rise in total urinary hCG and had hip fracture (n=1) and died (n=2) within 4 and 10 months, respectively. Elevated urinary hCG was of the malignant hyperglycosoloated isoform. Serum malignant hyperglycosolated hCG values in all of the cancer patients exceeded the maximal serum malignant hCG level of the PHPT subjects with benign disease (3.77 pmol/l).

Conclusion: hCG, especially its hyperglycosolated isoform, might add diagnostic and prognostic information in parathyroid cancer. Further studies would help to elucidate the role of hCG as a potential tumor marker in this disease.