Evaluation of Anti-Thyroperoxidase (A-TPO) and Anti-Thyroglobulin (A-Tg) Antibodies in Women with Previous Hashimoto's Thyroiditis during and after Pregnancy.

Background/Objective: Autoimmune thyroid diseases (AITD) affect 2 to 5% of the general population. This study aimed to determine changes in activity of A-Tg and A-TPO antibodies before, during, and after pregnancy in women with previous AITD. Methods: This was a single-center study with a retrospective review of the medical records of 30 female patients aged 25-41 years who came to our endocrinology service in the city of Santo André, state of São Paulo, Brazil, to investigate thyroid diseases. The following data were reviewed: total triiodothyronine (totalT3), total thyroxine (totalT4), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and anti-TSH receptor antibodies (anti-TSH receptor or anti-thyrotropin receptor antibodies (TRAb), anti-thyroid peroxidase (A-TPO), and anti-thyroglobulin (A-Tg)). These data were reviewed for 30 patients before and during the three trimesters of pregnancy and during the three months after pregnancy. Results: During gestation, we observed a progressive decrease in the blood values of A-TPO and A-Tg, which reached their lowest values in the third trimester of pregnancy, but after birth, they returned to values statistically equivalent to those before pregnancy. Analyzing the three trimesters and the post-pregnancy period, A-TPO increased 192% between the first trimester and postpartum (p = 0.009); it increased 627% between the second trimester and postpartum (p < 0.001); and it increased >1000% between the third trimester and postpartum (p < 0.001). There was no significant difference in the A-TPO values between the pre- and post-gestational periods (p = 1.00), between the first and second trimesters (p = 0.080), or between the second and third trimesters (p = 0.247). Conclusions: According to the results presented here, we observed changes in the activities of A-Tg and A-TPO antibodies during and after pregnancy in women with previous AITD. In women who intend to become pregnant, are pregnant, or have given birth within three months, it is essential to monitor A-TPO, A-Tg, and thyroid function as well as serum thyroid hormones and TSH to identify thyroid dysfunction in a timely manner and adjust the treatment strategy to avoid the deleterious effects of hypothyroidism on both mother and baby during and after pregnancy.

Manejo de la neoplasia trofoblástica gestacional. A propósito de un caso

La enfermedad trofoblástica gestacional es definida como un grupo heterogéneo de lesiones, las cuales surgen a partir del epitelio trofoblástico de la placenta luego de una fertilización anormal. Se presenta el caso de una paciente de 35 años de edad, con diagnóstico de neoplasia trofoblástica gestacional posmolar en etapa I, que se detectó tras estudios imagenológicos de seguimiento y determinación de la hormona gonadotropina coriónica humana, para lo cual llevó tratamiento con quimioterapia y terapéutica de mantenimiento con metotrexato por 5 días o metotrexato/ácido folínico por 8 días, hasta la normalización de la gonadotropina coriónica humana. Lo más relevante es que, aunque estos tumores abarcan menos del 1 % de los tumores ginecológicos, representan una amenaza para la vida de las mujeres en edad reproductiva.

Gestational trophoblastic disease is defined as a heterogeneous group of lesions, which arise from the trophoblastic epithelium of the placenta after abnormal fertilization. The case of a 35-year-old female patient is presented with a diagnosis of posmolar gestational trophoblastic neoplasia in stage I, which was detected after follow-up imaging studies and determination of human chorionic gonadotropin, for which she underwent chemotherapy treatment and maintenance therapy with methotrexate for 5 days or methotrexate/folinic acid for 8 days, until normalization of human chorionic gonadotropin The most relevant thing is that, although these tumors comprise less than 1% of gynecological tumors, they represent a threat to the life of women of reproductive age.

Using GnRH agonists in combination with hCG in antagonist ART cycles: A SCOPING Review of recent evidences.

Assisted Reproductive technology encompasses all techniques involving ovarian stimulation to produce high-quality oocytes and manipulation of both oocytes and sperm in vitro to produce embryos for the purpose of reproduction. The final maturation of oocytes induced by a "trigger" is a crucial step with the potential to affect in vitro fertilization outcomes. Human chorionic gonadotropin has traditionally been used as a substitute for luteinizing hormone to induce final oocyte maturation and meiosis. However, this practice may cause a potentially fatal iatrogenic complication known as ovarian hyperstimulation syndrome, which can cause significant morbidity and, in rare cases, death in otherwise healthy women. Thus, gonadotropin releasing hormone agonists have been promoted as a safer alternative for inducing oocyte maturation, albeit at the expense of luteal phase defect. Since then, various combinations of gonadotropin releasing hormone agonists and human chorionic gonadotropin have been tried. This scoping review evaluates these trigger combinations in various types of responders.

Persistently expressed human chorionic gonadotropin induces premature luteinization and progressive alterations on the reproductive axis in female mice.

The hypothalamic-pituitary-gonadal axis plays a fundamental role in the endocrine regulation of the reproductive function in mammals. Any change in the function of the participating hormones or their receptors can lead to alterations in sexual differentiation, the onset of puberty, infertility, cancer development, and other dysfunctions. In this study, we analyzed the influence of persistently elevated levels of the human chorionic gonadotropin hormone (hCG), a powerful agonist of pituitary luteinizing hormone (LH), on the reproductive axis of female mice. As a consequence of chronic hCG hypersecretion through a global expression of the hCGbeta-subunit in transgenic (TG) female mice, a series of events perturbed the prepubertal to juvenile transition. The imbalance in gonadotropin action was first manifested by precocious puberty and alterations in gonadal hormone production, with the consequent ovarian function disruption and infertility in adulthood. The expansion of cumulus cells in vivo and in vitro, ovulatory capacity, and gene expression of ovulation-related marker genes after hormone stimulation were normal in 3-week-old TG females. However, the expression of genes related to steroidogenesis and luteinization such as Lhcgr, Prlr, and the steroidogenic enzymes Cyp11a1, Cyp17a1, and Cyp19a1 were significantly elevated in the TG females. This study demonstrates that the excessive secretion of hCG in concert with high prolactin, induced premature luteinization, and enhanced ovarian steroidogenesis, as was shown by the up-regulation of luteal cell markers and progesterone synthesis in the TG mice. Furthermore, progressively impaired reproductive function of the TG females occurred from the peripubertal stage to adulthood, thus culminating in infertility.

Presentation, medical complications and development of gestational trophoblastic neoplasia of hydatidiform mole after intracytoplasmic sperm injection as compared to hydatidiform mole after spontaneous conception - a retrospective cohort study and literature review.

OBJECTIVE: To describe the natural history of hydatidiform mole (HM) after intracytoplasmic sperm injection (ICSI), emphasizing the clinical and oncological outcomes, as compared to patients who had HM after spontaneous conception (SC). STUDY DESIGN: Retrospective historical cohort study of patients with HM followed at the Rio de Janeiro Federal University, from January 1st 2000-December 31st 2020. RESULTS: Comparing singleton HM after SC to those following ICSI there were differences in terms of maternal age (24 vs 34 years, p < 0.01), gestational age at diagnosis (10 vs 7 weeks, p < 0.01), preevacuation human chorionic gonadotropin levels (200,000 vs 99,000 IU/L, p < 0.01), occurrence of genital bleeding (60.5 vs 26.9%, p < 0.01) and hyperemesis (23 vs 3.9%, p = 0.02) at presentation, and time to remission (12 vs 5 weeks, p < 0.01), respectively. There were no differences observed in the cases of twin mole, regardless of the form of fertilization that gave rise to HM, except molar histology with greater occurrence of partial hydatidiform mole (10.7 vs 40.0%, p = 0.01) following ICSI. Univariate logistic regression for occurrence of postmolar GTN after ICSI identified no predictor variable for this outcome. However, after adjusting for maternal age and complete hydatidiform mole histology, multivariable logistic regression showed the risk of GTN with HM after ICSI had an adjusted odds ratio of 0.22 (95%CI:0.05-0.93, p = 0.04), suggesting a possible protective effect when compared to HM after SC. CONCLUSIONS: Singleton HM after ICSI are diagnosed earlier in gestation, present with fewer medical complications, and may be less likely to develop GTN when compared with HM after SC.

Current chemotherapeutic options for the treatment of gestational trophoblastic disease.

INTRODUCTION: Gestational trophoblastic neoplasia (GTN) is a rare tumor that arises from trophoblastic tissues with high remission rates after chemotherapy treatment. GTN can develop from any gestational events, such as miscarriage, ectopic pregnancy, and preterm/term pregnancy, but is more frequent after hydatidiform mole. The sensitivity of this tumor to chemotherapy and the presence of an exceptional tumor marker allow high remission rates, especially when patients are treated in referral centers. AREAS COVERED: Observational, retrospective, prospective, systematic reviews, and meta-analysis studies focusing on GTN treatment. We searched PubMed, Medline, and the Library of Congress from January 1965 to May 2022. EXPERT OPINION: Early GTN diagnosis allows low-toxic and highly effective treatment. Even multimetastatic disease has high rates of remission with multiagent regimen chemotherapy. Surgery is reserved for uterine disease in patients who have completed childbearing, in cases of chemoresistance to multiagent regimens or in the rare cases of placental site trophoblastic tumor or epithelioid trophoblastic tumor. While resistance is managed by salvage chemotherapy, cases with limited clinical response to sequential regimens have been successfully treated with immunotherapy.

Tumor trofoblástico de sitio placentario secundario a mola parcial. Reporte de un caso / Placental site trophoblastic tumor secondary to partial mole. Report of a case

Resumen ANTECEDENTES: La enfermedad trofoblástica gestacional es un padecimiento que incluye un grupo de tumores placentarios, consecuencia de una proliferación anormal del tejido del trofoblasto. Se caracteriza por una excesiva elevación de la gonadotrofina coriónica humana que se considera diagnóstica y un predictor pronóstico. CASO CLÍNICO: Paciente de 23 años con hiperémesis gravídica y aumento del tamaño del útero mayor para las siete semanas de gestación y cuantificación de las concentraciones de HGC anormalmente elevadas en comparación con su valor basal. Se descartaron los diagnósticos diferenciales de mola parcial hidatiforme, mola completa y embarazo múltiple. Se concluyó que se trataba de enfermedad trofoblástica gestacional. Se procedió a la evacuación de la cavidad uterina de la que se extrajeron abundantes porciones de tejido ovoconformacional y molariforme. El informe de Patología fue: útero arcuato con tumor de sitio placentario, endometritis crónica, cervicitis con metaplasia escamosa, quiste de Nabot y endometrio proliferativo tardío. CONCLUSIÓN: Puesto que las pacientes con enfermedad trofoblástica gestacional suelen tener un pronóstico sombrío se sugiere la histerectomía simple para llegar a la curación. Por la agresividad del tumor y resistencia a otros tratamientos es indispensable el monitoreo riguroso semanal de la cuantificación de la HCG.

Abstract BACKGROUND: Gestational trophoblastic disease is a condition that includes a group of placental tumors resulting from abnormal proliferation of trophoblast tissue. It is characterized by an excessive elevation of human chorionic gonadotropin which is considered diagnostic and a prognostic predictor. CLINICAL CASE: 23-year-old patient with hyperemesis gravidarum and uterine enlargement greater than 7 weeks' gestation and abnormally elevated HGC levels compared to baseline. The differential diagnoses of hydatidiform partial mole, complete mole and multiple pregnancy were ruled out. It was concluded that it was gestational trophoblastic disease. The uterine cavity was evacuated and abundant portions of ovoconformal and molariform tissue were extracted. The pathology report was: arcuate uterus with placental site tumor, chronic endometritis, cervicitis with squamous metaplasia, Nabot's cyst and late proliferative endometrium. CONCLUSION: Since patients with gestational trophoblastic disease usually have a dismal prognosis simple hysterectomy is suggested to reach cure. Because of the aggressiveness of the tumor and resistance to other treatments, rigorous weekly monitoring of HCG quantification is indispensable.

Hipertiroidismo en una embarazada, posterior a una infección por SARS-CoV-2. Reporte de caso / Pregnant hyperthyroidism, after SARS-CoV-2 infection. Case report

Resumen ANTECEDENTES: El hipertiroidismo, en concurrencia con el embarazo, tiene una incidencia variable en los distintos trimestres de la gestación y puerperio. Predomina en el primer trimestre y a los 7 a 9 meses posparto. Se relaciona, principalmente, con enfermedad de Graves e hiperémesis gravídica por las concentraciones de gonadotropina coriónica humana. A partir del surgimiento de la infección por SARS-CoV-2 se documentó la asociación entre ambas enfermedades. CASO CLÍNICO: Paciente de 27 años, primigesta, con antecedente familiar materno de hipotiroidismo, con reporte de TSH pregestacional normal (2.3 mUI/mL). Al cabo de cuatro semanas de embarazo tuvo una infección no complicada por SARS-CoV-2, con prueba diagnóstica positiva de PCR. El diagnóstico y el tratamiento farmacológico fueron oportunos y se logró el estado eutiroideo que permitió suspender la medicación y mantener asintomática a la paciente desde el punto de vista endocrino. A las 36 semanas de embarazo se le diagnosticó preeclampsia severa, por lo que se decidió finalizar el embarazo mediante cesárea, con recién nacido masculino de 2550 g y 47 cm, sin complicaciones. En el seguimiento posparto la función tiroidea permaneció eutiroidea. CONCLUSIONES: En la paciente del caso fue aparente la relación entre la COVID-19 en el embarazo y el hipertiroidismo. El caso es de interés clínico porque permite analizar otros factores causales de la enfermedad tiroidea en el embarazo.

Abstract BACKGROUND: Hyperthyroidism associated with pregnancy has a variable incidence in different trimesters of pregnancy and puerperium. It predominates in the first trimester and at 7 to 9 months postpartum. It is mainly associated with Graves' disease and hyperemesis gravidarum due to human chorionic gonadotropin concentrations. Since the emergence of SARS-CoV-2 infection, the association between the two diseases has been documented. CLINICAL CASE: 27-year-old primigravida with a maternal family history of hypothyroidism and a reported normal pregestational TSH (2.3 mIU/mL). Four weeks into her pregnancy, she had an uncomplicated SARS-CoV-2 infection with a positive diagnostic PCR test. Diagnosis and pharmacologic treatment were timely, and euthyroid status was achieved, allowing discontinuation of the medication and keeping the patient asymptomatic from an endocrine standpoint. At 36 weeks' gestation, she was diagnosed with severe pre-eclampsia, and it was decided to terminate the pregnancy by cesarean section, with a male newborn weighing 2550 g and 47 cm without complications. At postpartum follow-up, thyroid function remained euthyroid. CONCLUSIONS: In the case patient, the association between COVID-19 in pregnancy and hyperthyroidism was evident. The case is of clinical interest because it allows the analysis of other causal factors of thyroid disease in pregnancy.

Interstitial ectopic pregnancy rupture at 17 weeks of gestation: A case report and literature review.

Interstitial pregnancy is a rare type of ectopic pregnancy that commonly results in uterine rupture and life-threatening haemorrhage. Interstitial ectopic pregnancies are associated with a 2-5% mortality rate and a high risk of uterine rupture before 12 weeks of gestation when compared to tubal pregnancy. Due to the thickness and distensibility of the interstitial segment of the Fallopian tube, ectopic pregnancy in this location attains a considerable size before complications arise. Unfortunately, this clinical entity may prove to be a diagnostic challenge, leading to delays in treatment and significant morbidity and mortality in women of reproductive age. Herein, we report a case of a ruptured interstitial ectopic pregnancy occurring at 17 weeks of gestation that was successfully managed with surgical intervention, after proving to be a diagnostic challenge.

Embarazo ectópico roto con fracción beta de la hormona gonadotropina coriónica humana negativa: reporte de caso / Ruptured ectopic pregnancy with negative human chorionic gonadotropin hormone beta fraction: case report

Resumen El embarazo ectópico roto es una emergencia quirúrgica cuyo diagnóstico, gracias a la interrelación de la cuantificación de la fracción beta de la hormona gonadotropina coriónica humana (HCG-β) y los hallazgos ultrasonográficos, se ha hecho más preciso. Sin embargo, el diagnóstico se vuelve difícil cuando clínicamente se encuentran datos sugestivos de embarazo ectópico con una HCG-β negativa. Presentamos el caso de una mujer de 25 años acude a valoración por referir 12,2 semanas de retraso menstrual, asociado a sangrado transvaginal y signos de irritación peritoneal, que cuenta con HCG-β negativa (< 5 mUI/ml). Se realizó un rastreo ultrasonográfico encontrando abundante líquido libre en cavidad, sin evidencia de embarazo intrauterino. Ante la alta sospecha de embarazo ectópico se realizó laparotomía exploradora, encontrando hallazgos sugestivos de embarazo ectópico roto, y se realizó salpingectomía. Finalmente, en el estudio posoperatorio se confirmó por histopatología un embarazo ectópico roto. Existen muy pocos reportes en la literatura internacional de pacientes con características clínicas de embarazo ectópico roto, con HCG-β negativa. Es importante la difusión de este tipo de casos con la finalidad de mejorar los abordajes diagnósticos y no restar importancia ante la sospecha clínica, a pesar de presentar una HCG-β negativa.

Abstract Broken ectopic pregnancy is a surgical emergency that due to the relation between the serum quantification of the of the beta subunit of human chorionic gonadotropin (β-HCG) and the ultrasonographic findings, there have been improvements to reach a precise diagnosis. However, there are very few reported cases in the literature where a broken ectopic pregnancy is described with negative serum results in β-HCG. We present a case report of a 25-year-old patient came to the evaluation for referring 12.2 weeks of menstrual delay, associated with transvaginal bleeding and data of peritoneal irritation, she had a negative β-HCG fraction (< 5 mIU/ml). A scan was performed ultrasound finding abundant free fluid in the cavity, without evidence of intrauterine pregnancy. Given the high suspicion of ectopic pregnancy, an exploratory laparotomy was performed, finding findings suggestive of a ruptured ectopic pregnancy, a salpingectomy was performed. Finally, in the postoperative study, a ruptured ectopic pregnancy was confirmed by histopathology. There are very few reported internationally were found a patient with clinical characteristics of broken ectopic pregnancy, with a β-HCG negative. It is important the scientific diffusion of this type of cases with the purpose of improving the diagnostic approaches and not underestimating importance to the clinical suspicion, despite presenting negative β-HCG results.

Primary germinoma of the medulla oblongata: illustrative case.

BACKGROUND: Primary central nervous system germinomas of the medulla oblongata are extremely rare and usually have been found in young female Asian patients. The authors present an illustrative case of a patient who presented with severe medullary and posterior cord syndrome, the first South American case published to date, to the authors' knowledge. OBSERVATIONS: Initially, the radiological differential diagnosis did not include this entity. The lesion was located at the obex and exhibited a well-delineated contrast enhancement without hydrocephalus. An emergency decompressive partial resection following functional limits was performed. After histological confirmation, radiotherapy was indicated, with complete remission achieved at a 6-month follow-up. The patient, however, continued to have a severe proprioceptive disorder. The literature review identified 21 other such patients. The mean age for this location was 23 years, with a strong female and Asian origin predilection. All tumors exhibited contrast enhancement, and only one presented with hydrocephalus. LESSONS: In the absence of elevated tumor markers, radiological clues such as a well-delineated, contrast-enhanced lesion arising from the obex, without hydrocephalus, associated with demographic features such as young age, female sex, and Asian heritage, should evoke a high level of suspicion for this diagnosis. Gross total resection must not be attempted, because this tumor is potentially curable with high-dose radiotherapy.

Severe thyrotoxicosis as initial presentation of gastric choriocarcinoma: a case report.

BACKGROUND: Extragonadal choriocarcinoma is rare and can be associated with hyperthyroidism when producing very high levels of human chorionic gonadotropin. CASE PRESENTATION: A 62-year-old Hispanic female presented with a 3-week history of shortness of breath, palpitations, extreme weakness, new-onset hot flashes, and right flank pain. Her physical examination was remarkable for tachycardia, hepatomegaly, hyperreflexia, and tremor; goiter was absent. Laboratory studies revealed increased lactate dehydrogenase, alkaline phosphatase, suppressed thyroid stimulating hormone, very elevated T4, and absent thyroid stimulating immunoglobulin. 18F-fluorodeoxyglucose positron emission tomography-computed tomography exhibited hepatomegaly with multiple large fluorodeoxyglucose-avid liver masses and a focus of fluorodeoxyglucose avidity in the stomach with no structural correlate. A thyroid scan (99mTcO 4 - ) showed diffusely increased tracer uptake. She was started on propranolol and methimazole. Upon stabilization of severe thyrotoxicosis, upper endoscopy was performed, showing a ~ 5 cm bleeding lesion in the greater stomach curvature body; biopsy was consistent with choriocarcinoma; beta-human chorionic gonadotropin hormone was 2,408,171 mIU/mL. The patient received methotrexate followed by etoposide and cisplatin. Methimazole was titrated down, and upon liver failure the medication was stopped. The thyrotoxicosis was effectively controlled with antithyroid drug and concurrent chemotherapy. At ~ 1.5 months after initial diagnosis, the patient died due to bleeding/acute liver failure with coagulation defects followed by multiple organ failure. CONCLUSIONS: Severe thyrotoxicosis can represent an unusual initial presentation of metastatic choriocarcinoma in the setting of extreme elevation of beta-human chorionic gonadotropin. Primary gastric choriocarcinoma is an aggressive malignancy with very poor outcomes. The co-occurrence of severe thyrotoxicosis with advanced primary gastric choriocarcinoma and imminent liver failure complicates management options.

Clinical characteristics and thyroid function in complete hydatidiform mole complicated by hyperthyroidism.

OBJECTIVES: To identify possible clinical factors associated with hyperthyroidism at presentation and to assess post-evacuation thyroid function in women with complete hydatidiform mole (CHM). METHODS: This observational study included women with CHM attending a specialized Brazilian center in 2002-2018. Clinical and laboratory data (serum hCG, TSH, fT4) were collected at presentation. Factors associated with hyperthyroidism were assessed by logistic regression. Receiver-operating characteristic curves were built to determine the hCG cutoff for predicting hyperthyroidism at CHM presentation. Post-molar evacuation follow-up included clinical assessment and close thyroid function monitoring. RESULTS: Of 137 CHM patients, 69 (50.3%) had hyperthyroidism of any type (43.5% subclinical, 56.5% overt) at presentation. Uterine fundal height > 16 cm or > gestational age (GA), and theca lutein cysts >6 cm were significantly associated with both subclinical and overt hyperthyroidism. The optimal hCG cutoff for predicting hyperthyroidism was 430,559 IU/L (sensitivity 85.5%, specificity 83.8%). Post-evacuation hyperthyroidism/transient hypothyroidism conversion was observed in 13% of the women with hyperthyroidism at presentation. Among the patients not showing conversion to hypothyroidism, median time for TSH normalization was 2 and 3 weeks for subclinical and overt hyperthyroidism, respectively. In the women with overt hyperthyroidism, fT4 was normalized at 2 weeks. CONCLUSIONS: Uterine fundal height > 16 cm, uterine fundal height > GA, theca lutein cysts >6 cm, and hCG >400,000 IU/L at presentation are associated with greater risk of hyperthyroidism and its complications. Close monitoring thyroid function during postmolar follow-up showed that, as thyroid hormones are normalized within 2-3 weeks post-evacuation, the use of beta-blockers or antithyroid drugs can be rapidly discontinued.

Suggested Cutoff Point for Testosterone by Liquid Chromatography with Tandem Mass Spectrometry (LC-MS/MS) after Stimulation with Recombinant Human Chorionic Gonadotropin.

The human chorionic gonadotropin (hCG) stimulation test that evaluates gonadal steroidogenesis is crucial in the assessment of patients with 46,XY disorders of sex development (DSD). This study aimed to determine a testosterone (T) cutoff level that indicates an adequate testicular function using LC-MS/MS after stimulation with recombinant human chorionic gonadotropin (rhCG) in a single dose. Nineteen prepubertal children with 46,XY DSD and normal T secretion were evaluated. T and dihydrotestosterone (DHT) levels were measured by liquid chromatography technique with tandem mass spectrometry (LC-MS/MS) before and 7 days after rhCG application at 250 µg. We suggest 0.89 ng/mL as the cutoff point for T after rhCG stimulation analyzed by LC-MS/MS.

Human chorionic gonadotropin affects original (ovulatory) and induced (accessory) corpora lutea, progesterone concentrations, and pregnancy rates in anestrous dairy goats.

Two experiments were conducted in acyclic Alpine (A) and Saanen (S) goats that received intravaginal sponges containing 60 mg of medroxyprogesterone acetate for 6 days, as well as 200 IU of eCG and 30 µg d-cloprostenol i.m. 24 h before sponge removal. On day 7 (day 0 = onset of synchronized estrus), all goats were randomly divided into two groups: animals treated with 300 IU of hCG i.m. (hCG; Exp.1: n = 8A; Exp.2: n = 75A + S) and untreated controls (Control; Exp.1: n = 8A; Exp. 2: n = 70A + S). In Exp.2, all goats were artificially inseminated. Transrectal ovarian ultrasonography and blood collection were done on days 7, 10, 13, 17, and 21 (Exp.1), and pregnancy detection on day 60 (Exp.2). Estrus and ovulations occurred in five hCG and seven Control animals. Accessory CL (aCL) were detected in all hCG does. The total luteal area of ovulatory corpora lutea (oCL) increased (P < 0.05) on day 10 in hCG does and remained greater (P < 0.05) than in Control until day 21. Total and high-velocity color Doppler area were greater (P < 0.05) for oCL of hCG does on days 13 and 17. Progesterone concentrations were greater (P < 0.05) in hCG does from days 13 to 21 and related directly to the total luteal and oCL area for the duration of the study in all does. The pregnancy rate was higher (P < 0.05) in hCG than in Control by 22.5 %. Human chorionic gonadotropin given on day 7 of the synchronized estrous cycle positively affected CL function and pregnancy rates in seasonally anovular dairy goats.

Difficulty in Diagnosing of Renal Choriocarcinoma: Case Report / Dificuldade no diagnóstico do coriocarcinoma renal: relato de caso

ABSTRACT Choriocarcinoma is a rare highly malignant tumor. We report a case of 35-year-old woman, with a history of four months menstrual irregularity and human chorionic gonadotropin persistently positive that presented transvaginal ultrasound normal and the computed tomography scan of the chest showed three nodules and abdominal scan evinced a hypervascularized solid nodular lesion on left kidney. An ultrasound-guided biopsy of left kidney was performed with a pathologic diagnosis of renal choriocarcinoma. After chemotherapy the human chorionic gonadotropin was negative and the patient returned to normal menstrual cicles.

RESUMO O coriocarcinoma é um tumor altamente maligno raro. Relatamos um caso de mulher de 35 anos, com história de irregularidade menstrual de quatro meses e gonadotrofina coriônica humana persistentemente positiva que apresentava ultrassonografia transvaginal normal e a tomografia computadorizada de tórax com três nódulos e a abdominal evidenciava um nodular sólido hipervascularizado lesão no rim esquerdo. Uma biópsia guiada por ultrassom do rim esquerdo foi realizada com diagnóstico patológico de coriocarcinoma renal. Após a quimioterapia, a gonadotrofina coriônica humana foi negativa e a paciente retornou aos ciclos menstruais normais.

Video Hysteroscopy in the Diagnosis of Molar Pregnancy in two Challenging Situations: Complete Mole with Normal hCG and Partial Mole with Early Gestational Age.

STUDY OBJECTIVE: To present the first hysteroscopic findings of 2 cases of complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM) within the context of the patients' clinical histories. DESIGN: Presentation of 2 hysteroscopic videos with narration of the intrauterine findings of molar pregnancy (MP) from Rio de Janeiro Gestational Trophoblastic Disease Reference Center. SETTING: MP is characterized by abnormal fertilization that generates 2 clinical syndromes: CHM and PHM [1]. INTERVENTIONS: In the first case, the patient was aged 50 years, and hysteroscopy was indicated to assess abnormal uterine bleeding in the presence of normal serum human chorionic gonadotropin (hCG) and transvaginal ultrassonography showing an endometrial cavity with heterogeneous content. Hysteroscopy found translucent hydropic structures diagnosed as CHM. The negative hCG value was due to the hook effect (hCG after dilution: 2 240 000 IU/L). In the second case, an 18-year-old patient underwent hysteroscopy to assess the endometrial cavity with retained abortion at 7 weeks in which, during conservative management, the hCG level increased over 4 weeks from 25 000 IU/L to 58 000 IU/L. Hysteroscopy visualized the embryo with its umbilical cord and hydatidiform vesicles diagnosed as PHM. CONCLUSION: MP can be an incidental finding during hysteroscopy for abnormal uterine bleeding or retained abortion [2-4]. Knowing its morphology during hysteroscopy is helpful for the correct management of this uncommon clinical situation. Hysteroscopy as an adjunct diagnostic tool (not as first-line treatment for MP) can be of significant benefit in challenging clinical scenarios. Further studies should assess the possible risk of spreading molar cells into the peritoneal cavity owing to hysteroscopic fluid.

GnRH agonist in association with hCG versus hCG alone for final oocyte maturation triggering in GnRH antagonist cycles.

OBJECTIVE: To analyze gonadotropin-releasing hormone (GnRH) agonist in association with human chorionic gonadotropin (hCG) (dual triggering) versus hCG alone (conventional triggering) for final oocyte maturation triggering in GnRH antagonist cycles in an unselected population of Brazilian women. METHODS: This prospective case-control study involved 114 patients referred to autologous in vitro fertilization treatment between February 2018 and August 2019, recruited regardless of age, infertility factor or number of cycles. The patients were randomly allocated into two groups according to oocyte maturation triggering approach: group A (n = 48) - hCG only; and group B (n = 66) - hCG plus GnRH agonist. The main outcomes measured were the number of total and metaphase II (MII) oocytes retrieved. RESULTS: The groups were homogenous in terms of age. There were no moderate or severe ovarian hyperstimulation syndrome events. There were no statistical differences concerning total or MII oocytes retrieved between the groups (p > 0.05). The MII/total oocyte rate was 70.9% in group A, and 74.5% in group B (p = 0.679). There was no oocyte retrieved in 2/48 patients (4.16%) in group A, 1/66 (1.5%) in group B. There were no MII oocytes in 4/48 patients (8.3%) in group A, and 2/66 (3%) in group B. Age was directly correlated to the number of total and MII oocytes retrieved (p < 0.05). CONCLUSIONS: Dual triggering was equivalent to conventional hCH triggering in terms of the number of total and MII oocytes retrieved in the general population. Further studies are necessary to ascertain dual triggering indication in selected groups of women.

Could human chorionic gonadotropin modulate interleukin 1ß to be a successful pregnancy predictor or not?

OBJECTIVE: Reproductive medicine needs to find some ways to predict pregnancy outcomes and implantation, which are non-invasive and accurate. Immunologic factors and interleukins are good choices reported in the literature. The purpose of this study was to evaluate whether or not HCG administration can modulate interleukin 1ß as a successful pregnancy predictor. METHODS: This is a prospective cross-sectional study involving women with regular menstrual cycles who had frozen their embryos. They prepared their endometria with letrozole and human chorionic gonadotropin (HCG). Their interleukin 1ß serum levels were checked on the day of HCG administration and embryo transfer. Its value assesses pregnancy outcome. RESULTS: We had 44 women with mean age of 32.2±5.4, and clinical pregnancy rate of 31.8%, mean interleukin 1ß before and after HCG injection in women who did not achieve pregnancy was 15.82±6.68pg/ml before HCG injection and 18.38±13.76pg/ml on the embryo-transfer day. It was high, but not significant (p value=0.210). In those participants who had clinical pregnancy before HCG injection, the mean interleukin 1ß level was 17.29±7.00pg/ml and 29.72±10.41pg/ml on the day of embryo transfer, with significant changes (p value=0.001). CONCLUSION: HCG did increase the mean level of interleukin 1ß, but it was not significant. High interleukin 1ß level is a significant predictor of successful pregnancy in IVF cycles.

Histopathological Changes that Occur on the Testicular and Penile Tissues Depending on the Treatment of Human Chorionic Gonadotropin: Rat Model

ABSTRACT Objective: To examine the histopathological effects of human chorionic gonadotropin (hCG) treatment on the penile and the testicular tissue in rat model. Methods: The rats of the hCG group (n = 8) were given daily subcutaneous injections of 50 IU of hCG for 15 days (Pregnyl, Organon). Rats of the control group (n = 8) received subcutaneous isotonic saline. All rats were sacrificed at the 1st month after hCG administration. After the received tissue samples were examined, germinal epithelial cell thickness, seminiferous tubule diameter, internal diameter of the tubules, the number of germ cell layers in the testicular tissue, and the diameters of penis, cavernous sinus lumen diameters and collagen tissue amount in the cavernous sinus surrounding were assessed in the sections prepared from the penis. Results: It was detected that there was a decrease in the testis weight, atrophy in the tubules, reduction in spermatogenesis, decrease in the mature spermatocytes, lower mean thickness and the number of cell layers of the germinal membrane in testicular tissue in the hCG group. It was found that the amount of collagen in the penile tissue was significantly higher in the hCG group and the diameters of cavernosal sinus lumens, and diameter of the penis were significantly lower in the hCG group. Conclusion: Human chorionic gonadotropin led to the deterioration in testicular histology and the histological changes in the penile tissue. The degradation in the testicular tissue and these changes formed in the penile tissue may affect the erectile tissue function.