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Severe liver injury due to hyperemesis gravidarum

Sutton 2003; Khanlian et al. 2003). The USA hCG Reference Service also reported 189 cases with no pregnancy or tumour; 121 were quiescent GTD and 61 had phantom hCG. The remaining seven cases had hCG of pituitary origin; hCG subsequently suppressed by combined oestrogen and progesterone therapy (Cole and Khanlian 2004). The Yale Trophoblast Centre reported nine cases with persistently elevated real, unexplained hCG, one subsequently developed placental site trophoblastic tumour metastatic to the lung and the remaining continue to be observed with no sign of gestational trophoblastic neoplasm (Kohorn 2001). At the 11th World Congress on Gestational Trophoblastic Disease 2001, over 70 cases of persistently elevated hCG were reported from four trophoblast centres (Hancock et al. 2001; Kohorn 2001; Cole and Butler 2001; Newlands et al. 2001). The opinion of the majority of experts is to refrain from immediate chemotherapy and/or surgery but to monitor such patients carefully and repeatedly (even over many years), looking for evidence of tumour or a definite rise in hCG values. Hyperglycosylated hCG (or invasive trophoblast antigen, ITA), a marker of invasive trophoblastic cells, may help in differentiating invasive from non-invasive disease.