一名无性生活的年轻女性体内的人类绒毛膜促性腺激素水平升高。

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Natalie Mira Elder, Ashley McCormick
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引用次数: 0

摘要

背景:在急诊科(ED)进行人绒毛膜促性腺激素(hCG)定量和定性检测,以确定育龄女性是否怀孕。通常认为 hCG 阳性结果表明宫内妊娠或其他形式的妊娠。然而,hCG 水平升高也可能是由卵巢肿瘤、垂体瘤和甲状腺疾病等其他疾病引起的。颅内生殖细胞瘤是罕见的能分泌 hCG 的中枢神经系统肿瘤,主要影响青少年和年轻女性:一名 16 岁的女学生因间歇性双侧额部头痛两天到我院急诊就诊,既往无明显病史。末次月经开始于就诊前两天。头痛伴有畏声、畏光、恶心和呕吐。血清定量 hCG 升高。她否认有性活动或性侵犯史。经腹超声检查未发现宫内妊娠。妇产科和儿科肿瘤科会诊。随后的检查,包括脑部成像,发现右侧尾状核和胼胝体有一个3.5厘米的肿块。患者被诊断为颅内非erminomatous生殖细胞肿瘤,需要住院治疗并立即开始化疗。急诊医生为什么要注意这一点?定量 hCG 升高并不总是怀孕的征兆,尤其是对于没有性生活史的年轻患者。在经腹超声检查未显示妊娠的情况下,应咨询妇产科,讨论进一步的检查和成像。急诊医生应将恶性肿瘤列为鉴别诊断的重点,因为需要及时进行化疗、外科评估和计划生育。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Increased Human Chorionic Gonadotropin Level in a Nonsexually Active Young Female.

Background: Quantitative and qualitative human chorionic gonadotropin (hCG) tests are obtained in the emergency department (ED) to determine if a female of child-bearing age is pregnant. A positive hCG result is commonly assumed to indicate an intrauterine or other form of pregnancy. However, elevated hCG levels can also result from various other conditions, such as ovarian tumors, pituitary tumors, and thyroid disorders. Intracranial germ cell tumors, rare central nervous system tumors capable of secreting hCG, primarily affect adolescent and young adult females.

Case report: A 16-year-old female student without significant past medical history presented to our ED with a complaint of intermittent bilateral frontal headache for two days. Last menstrual period started two days prior to presentation. The headache was associated with phonophobia, photophobia, nausea, and vomiting. Serum quantitative hCG was elevated. She denied history of sexual activity or sexual assault. Transabdominal ultrasound was negative for intrauterine pregnancy. Obstetrics and gynecology as well as pediatric oncology were consulted. Subsequent investigations, including brain imaging, revealed a 3.5 cm mass in the right caudate nucleus and corpus callosum. The patient was diagnosed with an intracranial nongerminomatous germ cell tumor, necessitating hospitalization and prompt initiation of chemotherapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: An elevated quantitative hCG is not always indicative of pregnancy, especially in a young patient without sexual history. In the case of a nonrevealing transabdominal ultrasound, obstetrics and gynecology should be consulted for discussion of further testing and imaging. Emergency physicians should include malignancy high on their differential since prompt initiation of chemotherapy, evaluation by surgical services, and family planning will be required.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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