Akitoshi Takizawa1, Koji Kawai2, Takashi Kawahara2, Takahiro Kojima2, Satoru Maruyama3, Nobuo Shinohara3, Shusuke Akamatsu4, Tomomi Kamba4, Terukazu Nakamura5, Osamu Ukimura5, Ryosuke Jikuya6, Takeshi Kishida6, Kenichi Kakimoto7, Kazuo Nishimura7, Toru Harabayashi8, Satoshi Nagamori8, Shinichi Yamashita9, Yoichi Arai9, Yoshitomo Sawada10, Noritoshi Sekido10, Hidefumi Kinoshita11, Tadashi Matsuda11, Tohru Nakagawa12, Yukio Homma12, Hiroyuki Nishiyama2. 1. Department of Urology, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumu-ku, Yokohama, Knagawa, 245-0006, Japan. takizawa-jua@umin.net. 2. Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan. 3. Department of Renal and Genitourinary surgery, Hokkaido University, Kita-8, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-0808, Japan. 4. Department of Urology, Kyoto University, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan. 5. Department of Urology, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. 6. Department of Urology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan. 7. Department of Urology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 541-8567, Japan. 8. Department of Urology, Hokkaido Cancer Center, 4-2-3-54 Kikusui, Shiroishi-ku, Sapporo, Hokkaido, 003-0804, Japan. 9. Department of Urology, Tohoku University Graduate School of Medicine, 2-1-1 Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan. 10. Department of Urology, Toho University Ohashi Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan. 11. Department of Urology and Andrology, Kansai Medical University, 3-1 Shinmachi 2 Chome, Hirakata, Osaka, 573-1191, Japan. 12. Department of Urology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Abstract
OBJECTIVE: The pituitary production of human chorionic gonadotropin (hCG) can cause false-positive results during or after germ cell tumor (GCT) treatment. Because hypogonadism leads to pituitary hCG production, testosterone administration test (TAT) has been recommended for pituitary hCG diagnosis. However, little is known about its efficacy for the discrimination of pituitary hCG as detected by currently used hCG assays in treatment of GCT. We conducted a retrospective multicenter study to determine the usefulness of TAT. MATERIALS AND METHODS: The study included 60 patients who underwent TAT for the discrimination of pituitary hCG. In principle, serum hCG levels were measured 1 week after testosterone enanthate administration (250 mg). When the serum hCG levels decreased below the normal upper range, the results of TAT were determined positive. In this case, the elevated hCG was considered to be derived from pituitary and not from GCT. RESULTS: Serum hCG levels were normalized after TAT in 36 of 60 patients (60%). Before TAT, the hCG levels were below 1.0 IU/L in 13 patients (36%), 1.0-1.9 IU/L in 11 (31%), 2.0-2.9 IU/L in 7 (19%), and >3.0 IU/L in 5 (14%) of TAT-positive patients. Of them, 28 (78%) patients were successfully managed without further treatment with chemotherapy after TAT. Pituitary hCG was associated with higher levels of LH and not necessarily associated with low levels of testosterone. CONCLUSION: Determining the TAT status of patients was effective in discriminating pituitary hCG production.
OBJECTIVE: The pituitary production of humanchorionic gonadotropin (hCG) can cause false-positive results during or after germ cell tumor (GCT) treatment. Because hypogonadism leads to pituitary hCG production, testosterone administration test (TAT) has been recommended for pituitary hCG diagnosis. However, little is known about its efficacy for the discrimination of pituitary hCG as detected by currently used hCG assays in treatment of GCT. We conducted a retrospective multicenter study to determine the usefulness of TAT. MATERIALS AND METHODS: The study included 60 patients who underwent TAT for the discrimination of pituitary hCG. In principle, serum hCG levels were measured 1 week after testosterone enanthate administration (250 mg). When the serum hCG levels decreased below the normal upper range, the results of TAT were determined positive. In this case, the elevated hCG was considered to be derived from pituitary and not from GCT. RESULTS: Serum hCG levels were normalized after TAT in 36 of 60 patients (60%). Before TAT, the hCG levels were below 1.0 IU/L in 13 patients (36%), 1.0-1.9 IU/L in 11 (31%), 2.0-2.9 IU/L in 7 (19%), and >3.0 IU/L in 5 (14%) of TAT-positive patients. Of them, 28 (78%) patients were successfully managed without further treatment with chemotherapy after TAT. Pituitary hCG was associated with higher levels of LH and not necessarily associated with low levels of testosterone. CONCLUSION: Determining the TAT status of patients was effective in discriminating pituitary hCG production.
Authors: Ann M Gronowski; Corinne R Fantz; Curtis A Parvin; Lori J Sokoll; Carmen L Wiley; Mark H Wener; David G Grenache Journal: Clin Chem Date: 2008-02-07 Impact factor: 8.327