with best wishes
Richard
Richard Mainwaring-Burton
Consultant Biochemist
South London Healthcare Trust
Queen Elizabeth Hospital, Woolwich
Princess Royal Hospital, Farnborough
Queen Mary's Hospital, Sidcup
020-8836-5724
mob: 07831-739876
Patient attended ED with abdominal pain, a repeat blood tests showed:
Ultrasound showed ectopic pregnancy.
So gonadotrophins are not suppressed in some ectopic pregnancies whrere oestradiol and progesterone production is blunted and hence no negative feedback on pituitary gonadotrophins.
Now this is a new learning case for me and wonder if some of you have observed such detectable gonadotrophins associated with ectopic gestation.
The beta-hCG on the second case is very high as expected at 37850 IU/L.
Just to continue with this theme, I came across a puzzle late yesterday, another hormonal profile on a 30-year-old lady with irregular menstrual bleed, request from GP via order comm, results are:
Now, I need some help to explain this high beta-hCG in the face of what looks like normal follicular phase gonadotrophins. All tests were double checked and there was no urine sent for pregnancy test. I shall ask for a repeat next week, but in the meantime any explanation is welcome.
Many thanks for the many replies I have received so far, most of you correctly identified the possibilty of pregnancy and asked for Beta-hCG result which was 270 IU/L confirming very early pregnancy.
One colleague said he would put a comment "congratulations she is pregnant now"; though I wouldn't say congratulations yet as this is very early pregnancy and may be even occult ending by the next period.
Incidentally this pm, there was another hormonal profile on a very young lady with irregular periods from a GP via order comm, this showed:
Even if I am confident that she is well into her pregnancy, I wouldn't say congratulations as it could be an unwanted pregnancy.
So is this sort of request excessive? it all depends on the clinical situation they are investigating, for example in the first instance if they were only assessing luteal function/ovulation then requesting day 21 progesterone is sufficient. While in the second case they are investigating possible PCO, so the request is justified.
A GP requested the following hormones on a young female patient with a clinical detail of "infertility"; the request came via the GP order comm system and the results were as follows:
What would be your comment? would you consider this as excessive requesting?
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist