Abstract
Background. Although the association between human chorionic gonadotropin (hCG) and hyperandrogenism was identified more than 40 years ago, relevant questions remain unanswered. Design and Methods. We conducted a prospective, longitudinal, and controlled study in 23 women with a diagnosis of a complete hydatidiform mole (HM). Results. All participants completed the study. Before HM evacuation mean hCG was markedly higher in the cases than in the control group (P ≤ 0.001). Free testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) were found to be higher in the cases (2.78 ± 1.24 pg/mL and 231.50 ± 127.20 μ/dL) when compared to the control group (1.50 ± 0.75 pg/mL and 133.59 ± 60.69 μ/dL) (P = 0.0001 and 0.001), respectively. There was a strong correlation between hCG and free T/total T/DHEA-S concentrations (r = 0.78; P ≤ 0.001, r = 0.74; P ≤ 0.001, and r = 0.71; P ≤ 0.001), respectively. In the cases group 48 hours after HM evacuation, hCG levels were found to be significantly lower when compared to initial levels (P = 0.001) and free T and DHEA-S declined significantly (P = 0.0002 and 0.009). Conclusion. Before uterus evacuation, hCG, free T, and DHEA-S levels were significantly higher when compared with controls finding a strong correlation between hCG and free T/DHEA-S levels. Forty-eight hours after HM treatment hCG levels declined and the difference was lost. A novel finding of our study is that in cases, besides free T, DHEA-S was also found to be significantly higher and both the ovaries and adrenal glands appear to be the sites of this androgen overproduction.
Highlights
Gestational trophoblastic disease (GTD) includes a heterogeneous group of pathologies that arise from anomalous proliferation of trophoblastic cells [1, 2]
Observational, and controlled study we found that in women with complete hydatidiform mole (HM), before uterus evacuation, human chorionic gonadotropin (hCG), free T, and dehydroepiandrosterone sulfate (DHEA-S) were significantly higher when compared with age, weight, and gestational age-matched controls
A strong correlation between hCG and total T/free T/DHEA-S concentrations was found and forty-eight hours after HM treatment hCG levels decreased and both free T and DHEA-S concentrations returned to normal values
Summary
Gestational trophoblastic disease (GTD) includes a heterogeneous group of pathologies that arise from anomalous proliferation of trophoblastic cells [1, 2]. It has been recognized that due to these biochemical and molecular similarities, supraphysiological concentrations of one of these hormones can generate the biological effect of the other This relatively high sequence identity between the hormonebinding domains has been called “spillover phenomenon” and has been classically described during pregnancy as being responsible for hCG-mediated hyperthyroidism [6,7,8]. Free testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) were found to be higher in the cases (2.78 ± 1.24 pg/mL and 231.50 ± 127.20 μ/dL) when compared to the control group (1.50 ± 0.75 pg/mL and 133.59 ± 60.69 μ/dL) (P = 0.0001 and 0.001), respectively. In the cases group 48 hours after HM evacuation, hCG levels were found to be significantly lower when compared to initial levels (P = 0.001) and free T and DHEA-S declined significantly (P = 0.0002 and 0.009). A novel finding of our study is that in cases, besides free T, DHEA-S was found to be significantly higher and both the ovaries and adrenal glands appear to be the sites of this androgen overproduction
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