HCG in blood (bad) surprise!
January 3, 2011 7:58 PM   Subscribe

Surprise abnormal HCG result? Has this happened to anyone else? Anything you can share that might give me some perspective on this? (Yes, I have an email in to my PCP).

I went to ER over the weekend (with a non-illness-related, and now solved issue), and while I was there they ran some standard blood work including a pregnancy test. My HCG level came back at 1.4 (whatever the standard unit is, I didn't see), and the doctor I saw told me there should not be any HCG in my blood at all unless I'm pregnant (I'm not, as it's both just not logistically possible, and the HCG level was too low) and to follow up and get it checked out. He said "We see this every few months", asked me what other health issues I have, and checked I wasn't on the HCG fad diet (I'm not).

I'm 30 and mostly healthy, but I have unexplained irregular periods (they have never been regular) that I've been having tests around on and off as my health insurance comes and goes. I do not have early menopause, and it's not a clear-cut case of PCOS. Lately my periods have been more regular than before, and accompanied by little cramps and twinges throughout the month that I just assumed were part of my cycle. I'm also a little bit overweight, have various allergies, and gallstones that haven't bothered me for years.

I know you shouldn't diagnose yourself on the internet, etc, but like many women I've had to do a lot of the legwork of figuring out my previous hormone and fertility issues, so I was interested to see if this might be a piece of the puzzle. No, says the internet, if it's not pregnancy it's a germ cell tumor (probably ovarian cancer), no other reason to have HCG in your blood.

I have an email in to my PCP and I'm waiting for her to get back to me, but I'm really, really upset and sad. I'm finding it hard to do anything except think about death and what will happen to my partner (who already lost a parent very young). We're in the middle of planning a big move to be near family, our health insurance situation is insecure and I'm unemployed. I don't know what this will mean for all that. All around it just sucks.

Has anyone else dealt with this kind of test result or with ovarian cancer? Can anyone with a medical background give me some more info on this kind of situation. I absolutely get that you're not my doctor and I don't even have a diagnosis yet, but while my PCP is good, she isn't one for providing much extra info, and I like to know as much as I can.
posted by anonymous to Health & Fitness (10 answers total) 2 users marked this as a favorite
I am not a doctor, I just like to find decent resources for stuff on the internet. Skipping Wikipedia, this page at the University of Michigan's health system seems to be saying that tiny levels [less than five IU/L, which is what you have] of hCG in the blood of non-pregnant women sometimes happens. In the urine this does not happen and you should be seeing zero levels. Nothing much to add to this except that internet research for medical stuff is generally a terrible idea for exactly this reason. I hope you are fine.
posted by jessamyn at 8:07 PM on January 3, 2011 [3 favorites]

If you've had other underlying weirdness around your periods, your GP may refer you to a reproductive endocrine specialist for more testing and more reassurance.

You've got a lot going on. Try to stay calm and let your doctors deploy the science; if nothing else, it won't help to run up your blood pressure and deprive yourself of sleep if you actually do have a medical issue of notable concern.
posted by fairytale of los angeles at 8:22 PM on January 3, 2011

Did your ER doctor say anything about an ultrasound? If you are worried, you might want to ask your GP to refer you for a pelvic ultrasound. As far as I know, ovarian tumors show up on them, and it's not uncommon for GPs to request pelvic ultrasounds based on unusual blood test results. If there is something, you'll know, and if there isn't, tumor-less images are probably the best thing to help you feel reassured. If your GP won't refer you for an ultrasound, go to another doctor.

(I am so, so not a doctor, but I work in an admin capacity in a gynae ultrasound practice.)
posted by equivocator at 9:18 PM on January 3, 2011

A good friend of mine had a positive pregnancy test prior to a surgical procedure a couple of years ago, despite not having had sex with a man in a couple of decades. She was told that there are tumors, which can be anywhere in the body, that secrete HCG, and at one point she had a head-to-toe MRI to look for one. When that test, and some other tests, didn't show anything, she was told that some women just have some HCG in their blood chronically (she was told that she would probably always have positive blood tests for pregnancy) and nobody knows why but it doesn't seem to be a big deal, and that she should just not worry about it. So that's what she's been doing ever since.
posted by not that girl at 9:36 PM on January 3, 2011

Please don't be upset.

Your test result was normal for a nonpregnant person. I'm sorry the ER doctor misled you.

A serum quantitative hCG can be <5 in a nonpregnant person, as jessamyn noted. Don't worry! You don't need an RE specialist or an ultrasound. You're not pregnant!
posted by treehorn+bunny at 9:36 PM on January 3, 2011

Even if it *is* ovarian cancer, that's not an automatic death sentence. I have a hale and hearty 60-year-old friend who survived ovarian cancer two years ago.
posted by amtho at 10:00 PM on January 3, 2011

"No, says the internet, if it's not pregnancy it's a germ cell tumor (probably ovarian cancer), no other reason to have HCG in your blood ... I'm really, really upset and sad. I'm finding it hard to do anything except think about death and what will happen to my partner (who already lost a parent very young)."

Oh, you poor thing, you are getting ahead of things. IANA MD, but here is what actual MDs say, and my translation for the overwhelmed underneath.

Clinical Gynecologic Endocrinology and Infertility, 7th Edition, eds. Leon Speroff and Marc A. Fritz, Lippincott Williams & Wilkins 2005, p.278:
"With the use of modern sensitive assays, it is now appreciated that virtually all normal human tissues produce the intact hCG molecule. hCG can be detected in the blood of normal men and women ... the source of this circulating hCG is the pituitary gland. The concentration of this pituitary hCG normally approximates the sensitivity of the usual modern assay, and for this reason, many laboratories will not report the presence of hCG unless the level is 10 IU/L or higher." (Emphases mine.)

Translation: Every adult secretes a little bit of hCG into the bloodstreams from the pituitary (a gland that sits under the brain). The margin of error of the serum hCG test is somewhere between 2 and 10 IU/L (or mU/mL, same thing), and so some labs don't report any value less than 2, less than 5, or less than 10, because they can't tell the value exactly and most healthy people have about that amount. Instead of 1.4 mU/mL, they'd write "below limit of detection" or "not detectable". Maybe the ER doc is used to that kind of lab report, where basically the only time he'd see a number instead of BLD or ND is if it's elevated. Maybe he just likes to yell at people about the hCG fad diet.

But depending on what reference range you use, normal for a premenopausal woman or for any male is less than10, less than 5, or less than 2 IU/L, all of which reference ranges include 1.4 IU/L.

None of this should stop you from talking to your doctor. But stay away from Dr. Google - he usually lies, and he really likes to upset people and make them think about death.
posted by gingerest at 10:23 PM on January 3, 2011 [11 favorites]

Do not panic. I have had the same result, in 1999 (imagine the surprise of the people who were testing me in preparation for egg donation!) and I was neither pregnant nor have I had any issues anywhere in my reproductive system since. Apparently, sometimes people who are not pregnant and don't have any issues in their reproductive system just make extra hCG, as gingerest says.
posted by Sidhedevil at 12:08 PM on January 4, 2011

As others have said, it is not unknown for some people to have low background levels of hCG in their system chronically. It's more common in post-menopausal women, but can be present in premenopausal women.

If the hCG were due to any kind of cancer, it would almost certainly be much much much higher than the level you got.
posted by *becca* at 1:52 PM on January 4, 2011

just wanted to apologize for skimming your question and assuming you were worried about pregnancy... I was in such a rush to assuage your concerns that I jumped to that conclusion and missed the part where you said pregnancy was impossible.

either way I hope you're feeling much more calm and reassured now. As an ER doctor I know that sometimes me and my colleagues don't have time to look up unusual test results or explain things as well as we should. I'm sorry for your experience.
posted by treehorn+bunny at 3:57 PM on January 4, 2011

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