What are the diagnostic considerations in a menopausal woman with a positive hCG test result?

Abstract

EVIDENCE-BASED ANSWER The most common causes of elevated human chorionic gonadotropin (hCG) in a menopausal woman are a false-positive test (42%), quiescent gestational trophoblastic disease (GTD; 41%), low level pituitary production (10%), and malignancy (7.6%). After repeating the test in blood and urine, active malignancy and quiescent GTD should be ruled out by obtaining hyperglycosylated hCG and hCG free β-subunit. A physiologic pituitary source of hCG is likely in women with persistent low levels of hCG (<25–32 mIU/mL). This finding can be confirmed by the normalization of hCG levels after the administration of combined oral contraceptives for 2 or more weeks (SOR: C, case series of disease-oriented evidence).