Abstract
Preoperative pregnancy testing is common practice among anesthesiologists. Little is re-ported in anesthesia literature on causes other than pregnancy for elevated human chorionic go-nadotrophin (hCG) levels. Among these causes is hCG secretion by tumors. This is a report of a female with pancreatic cancer that presented for a Whipple procedure, who on routine pregnancy testing was found to have an elevated hCG level. This unexpected result led to significant delay and undue stress for the patient. After determining pregnancy was unlikely and multiple poorly differentiated metastatic masses were discovered, it was decided that the most likely cause of her hCG levels was cancer. Multiple cancers have been reported to secrete hCG, and more specifically β hCG [1]. Studies of elevated hCG in pancreatic cancer patients report an incidence of 40% - 56% [2,3]. Serum β hCG testing done prior to the date of surgery (DOS) in cancer pa- tients that are pre- or perimenopausal should be considered as it would allow time for a more definitive pregnancy evaluation to be performed.
Highlights
In 2012 the American Society of Anesthesiologists (ASA) task force on preanesthesia evaluation stated “pregnancy testing may be offered to female patients of childbearing age and for whom the result would alter the patient’s management” [4]
The patient was informed of her diagnosis and chemotherapy was pursued with an oncologist. This case of a false positive pregnancy test most likely due to malignancy is one of the first in anesthesia literature to emphasize the importance of understanding and interpreting preoperative pregnancy tests
Β human chorionic go-nadotrophin (hCG) is primarily produced by syncytiotrophoblasts of the placenta to maintain progesterone secretion, which in turn maintains a healthy uterus for pregnancy [9]
Summary
In 2012 the American Society of Anesthesiologists (ASA) task force on preanesthesia evaluation stated “pregnancy testing may be offered to female patients of childbearing age and for whom the result would alter the patient’s management” [4]. It is not definitive if anesthesia is harmful to a pregnancy; the general consensus is that surgery should be delayed until after first trimester if not until after delivery [5]. While a prospective study of 315 women who had serum β hCG testing prior to surgery showed an unexpected positive result of 2.2% [6]. The following is a case report that demonstrates the potential inaccuracy of pregnancy tests as hCG levels can be elevated for reasons other than pregnancy such as advanced cancer or perimenopause
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
