Blood Chemistry-Human chorionic gonadotropin (βHCG)

in StemSocial2 years ago

bhcg 2.png

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This is a very interesting topic I'll have you know. So many people have been asking to learn more about βHCG.

I recently started my posting as an Intern Obstetrician and Gynecologist on the 11th of this month. It was long overdue because of the culture in the Teaching Hospital where I am training.

They have this "no moving Interns over the weekend and lockdown (still going on Monday)". The lockdown is because of the Eastern Solidarity with Nnamdi Kanu over his court case, so every Monday there is a lockdown to revolt against the government. And what better way could there be than to take away the state government's most important day..."MONDAY" from the work calendar.

The week of writing this post there is a 4-day lockdown that ends by 4 pm every day from Monday to Thursday.

But this is all by the way.

My first Ward round fail


Source

I hate to make myself look like the worse doctor in my stories...but I feel people find comedy easily in failure and just learn from other people's failures faster than their successes.

On my first day, they asked a question about the chemical marker for pregnancy and I failed it.

It's βHCG!! I slapped my forehead as my senior said the answer. He said I would beat myself up for not knowing it.

In my defense, it had been years since I last opened up a text in Obstetrics and Gynecology (ONG as it's called).

I also made a guess that made them realize it had been a while. My doctor friends like @bhao and @jaydr would say it was a total fail though.

I guessed Alpha-fetoprotein...absolute fail...but the SR was nice enough to say I tried.

The last excuse I will give myself is that they didn't exactly ask...

WHAT IS THE MARKER FOR PREGNANCY?

...I would have said I couldn't remember...

It was a case of a Molar Pregnancy...Gestational Trophoblastic Disease to GTD to be precise.

Gestational Trophoblastic Disease(GTD)

The patient is a 22-year-old who has been bleeding from her Vagina for some months now. We have placed her on a drug that is supposed to stop her bleeding but it has refused to stop. For those curious, the drug is called Tranexamic acid and it comes in tablets and injection preparations both of which have been used on the patient.

The bleeding just reduced, it's a little win but we still want to solve the problem causing the bleeding. It is like using a really big mop to dry up a floor from a medium-sized leak at this point...at some point, you will still find some moisture here and there.

What is the relationship between βHCG and GTD?

Well, GTD first of all is a type of pregnancy. forget that fact it is a disease. So the marker for pregnancy will be seen in the blood.

But what happens in GTD is that usually a woman who is already at risk of the disease (such as women below 20, over 35 years or have had the disease before) will produce an Ovum with no functional DNA and will get fertilized by a sperm and this will grow to form an abnormal placenta.

The placenta will then produce the marker for pregnancy βHCG but unlike the βHCG produced in normal pregnancy, the amount is between 2,000 to 40,000 times more than what you would have in normal pregnancy.

What did we do for her?

We placed her on a drug regimen known as EMACO. It is an acronym for all the drugs used to treat the disease these include etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine(Oncovin).

If you are an all-star medical doctor like @stormz-y you'll realize that these are chemotherapy medications and you'll start congratulating me or feeling bad for me that I am once again in an Oncology unit, this time in ONG.

Source

While GTD is not always a malignancy, there were a few reasons why we chose to give her chemo...she fit the description given in the International Federation of Gynecology and Obstetrics criteria:

(1) a rise in hCG levels of 10% or greater for ≥3 values over 2 weeks; (2) a plateau in ≥4 hCG values
over 3 successive weeks; (3) hCG levels elevated at 6 months post evacuation; or (4) a tissue diagnosis
of choriocarcinoma.

I am yet to find the particular figure that made my chiefs give her chemotherapy but it was one of these.

βHCG is a really weird molecule

bhcg 3.png

The molecule is a protein with two sides, the smaller alpha part and the bigger beta part.

The beta part is what we have been discussing (βHCG). The alpha part looks like Leutinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Thyroid Stimulating Hormone (TSH), and the beta subunit (βHCG).

LH and FSH have functions in the reproductive system in Preparing the body for pregnancy but TSH stimulates the thyroid gland.

There is a case report of GTD causing hyperthyroidism (Thyrotoxicosis) documented in the American Thyroid Association. I doubt it's very common that GTD would lead to thyroid disease seeing as it was taken up in a case report.

Take This With you

  • At least you know about the strange world around them "βHCG"molecule.
  • You know that it can be used as a marker for pregnancy.
  • When it is 2 to 40 K higher than pregnancy levels might be a GTD.
  • You know what GTD is.

Please consider sharing my work for more of your friends to see, upvote it and leave a comment. I look forward to having a conversation with you.

Keep being amazing!!

REFERENCE

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 2 years ago  

I really like the way you share your experience. It is quite pleasant to follow, except that as @alexanderalexis I got lost with all the acronyms ;)

To come back to the topic, is GTD thus considered as a cancer? I assume so as chemotherapy is used to treat it. But then what are the chances of success for the treatment? Thanks in advance for answering.

Cheers!

I assume so as chemotherapy is used to treat it.

Actually cancer drugs are often used for other conditions. One example is a chemotherapy drug called methotrexate that's often used for autoimmune conditions, since chemo drugs often dampen the immune system. See here for more detail.

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 2 years ago  

I had no idea this kinda thing could even happen to a girl a kind of pregnancy-but-not. Pretty scary stuff to experience... cool post and I appreciate the self-made art, I guess?

Not easy to keep up with all these acronyms!

Right...so sorry sbout that...maybe I'll put keys next time.