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Beta-hCG (bHCG or β-hCG) is a sex hormone found in the mother's blood serum that can be used to help interpret obstetric ultrasound findings.
Beta-hCG levels may be used in three ways in the clinical setting of pregnancy:
- qualitatively, for presence/absence of fetal tissue
- more often determined with a urine test than with a serum test
- includes or excludes a pregnancy-related differential in a female pelvic ultrasound
- quantitatively, for assessing if a pregnancy is meeting appropriate cut-off values for its age
- has been used in the first trimester to help determine if an ectopic pregnancy should be suspected
- quantitatively, for trending the growth rate of fetal tissue
"hCG" is an initialism for "human chorionic gonadotropin". Chorionic refers to the production of hCG from the syncytiotrophoblasts of the chorion which develop into the fetal placenta. Gonadotropin refers to a substance that regulates gonadal activity (for instance, FSH and LH, the two anterior pituitary gonadotropins, are in this class).
hCG consists of two moieties:
- an alpha (α) moiety that is similar to FSH, LH, and TSH, and a
- a beta (β) moiety that is unique to human chorionic gonadotropin
In view of this homology between hCG and other gonadotropins, all commercially-available assay kits test for the beta subunit only. This is to reduce the risk of inadvertently mistaking FH and LSH as part of the hCG fraction.
Markedly elevated beta-hCG levels may occur with gestational trophoblastic disease, whilst an abundance of the alpha subunit (of hCG) may cause hyperthyroidism 7.
The physiologic role of the hormone is to maintain the corpus luteum, thereby maintaining a favorable intrauterine environment for pregnancy.
NB: gonadotropin is the correct spelling; gonadotrophin is an antiquated spelling that should be avoided.
Quantitative for gestational sac visualization
The use of beta-hCG values to guide interpretation of first-trimester ultrasound findings has a long history. "Discriminatory levels" were first devised to indicate at what beta-hCG level a gestational sac should be seen 2. These levels are continually revised (values are in mIU/mL):
- fetal chorionic/placental tissue is present somewhere
- older cut off for visualization of an intrauterine gestational sac
Currently, it is discouraged to treat based on a single beta-hCG level in a hemodynamically-stable woman with a pregnancy of uncertain location 3.
Quantitative for trending
Beta-hCG values can also be used to determine if a pregnancy is progressing appropriately (until about ~10 weeks gestational age)
- <8 weeks of pregnancy (gestational age)
- beta-hCG level is assumed to double every ~48 hours 4
- 8-10 weeks of pregnancy
- beta-hCG level is assumed to double approximately every ~5 days 4
A pregnancy with vaginal bleeding and a beta-hCG level that is not increasing appropriately (or declining) is assumed to be an inevitable miscarriage 5, although solidity of this idea after 8 weeks and above a level of 5000 mIU/ml has been questioned 6.
Beta-hCG levels decrease rapidly in the first 1-2 weeks after delivery, termination or complete miscarriage and then the rate of decrease slows down beyond 2 weeks. At 6 weeks levels should be zero.
On ultrasound, the gestational trophoblastic disease may appear radiologically similar to retained products of conception (RPOC), but the two may be differentiated with beta-hCG.
- gestational trophoblastic disease: markedly elevated beta-hCG levels
- retained products of conception: falling beta-hCG levels
Beta-hCG levels may also be raised by some ovarian neoplasms (e.g. ovarian embryonal carcinoma, ovarian dysgerminoma), as well as in testicular germ cell tumors (e.g. seminoma, mixed germ cell tumor) 8 and choriocarcinoma. Non-gestational choriocarcinomas, while usually arising from gonadal organs (i.e. ovaries or testes), can arise from extragenital sites as diverse as the pineal gland, mediastinum, liver, gallbladder, retroperitoneum, and urinary tract. There are several case reports of beta-hCG-secreting non-small cell lung cancer (e.g. adenocarcinoma 9 and squamous cell carcinoma).
- 1. Polonsky KS, FRCP PRLMDFACP et-al. Williams Textbook of Endocrinology. Saunders. ISBN:1437703240. Read it at Google Books - Find it at Amazon
- 2. Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol. 1981;58 (2): 156-61. Pubmed citation
- 3. Doubilet PM, Benson CB. Further evidence against the reliability of the human chorionic gonadotropin discriminatory level. J Ultrasound Med. 2012;30 (12): 1637-42. Pubmed citation
- 4. Daya S. Human Chorionic Gonadotropin Increase in Normal Early Pregnancy. Am J Obstet Gynecol. 1987;156(2):286-90. doi:10.1016/0002-9378(87)90269-9
- 5. Davies S, Byrn F, Cole LA. Human chorionic gonadotropin testing for early pregnancy viability and complications. Clin. Lab. Med. 2004;23 (2): 257-64, vii. Pubmed citation
- 6. Konrad G. First-trimester bleeding with falling HCG: don't assume miscarriage. Can Fam Physician. 2007;53 (5): 831-2. Free text at pubmed - Pubmed citation
- 7. Yoshimura M & Hershman J. Thyrotropic Action of Human Chorionic Gonadotropin. Thyroid. 1995;5(5):425-34. doi:10.1089/thy.1995.5.425
- 8. Montgomery J, Weizer A, Filson C, Milose J, Khaled Hafez. Role of Biochemical Markers in Testicular Cancer: Diagnosis, Staging, and Surveillance. OAJU. 2011;4:1. doi:10.2147/oaju.s15063
- 9. Vicier C, Tabouret E, Tallet A et al. BetaHCG Secretion by a Pulmonary Adenocarcinoma. World J Surg Onc. 2013;11(1):228. doi:10.1186/1477-7819-11-228 - Pubmed