Significance of HCG to Distinguish Parathyroid Carcinoma from Benign Disease and in Adding Prognostic Information: A Hospital Based Study from Nepal

  • Gupta, Satrudhan Pd. (Department of Biochemistry, Nepalese Army Institute of Health Sciences) ;
  • Mittal, Ankush (Department of Biochemistry, Nepalese Army Institute of Health Sciences) ;
  • Sathian, Brijesh (Department of Community Medicine, Manipal College of Medical Sciences)
  • Published : 2013.01.31


Objective: To differentiate between benign and malignant hyperparathyroidism on the basis of excretion of HCG and its malignant isoforms in urine. Materials and Methods: This hospital based study was carried out using data retrieved from the register maintained in Manipal Teaching Hospital from $1^{st}$ January, 2008 and $31^{st}$ August, 2012. The variables collected were urinary HCG and HCG malignant isoform, calcium and parathyroid hormone. Preceding the study, approval was obtained from the institutional research ethical committee. Analysis was by descriptive statistics and testing of hypothesis. A p-value of <0.05 (two-tailed) was used to establish statistical significance. Results: Out of the 20 cases, 10 were primary hyperparathyroidism and the remainder were parathyroid carcinomas. The urinary HCG $6.1{\pm}0.6$ fmol/mgCr was with in normal range in benign hyperthyroidism but was markedly elevated in three cases of malignant hyperparathyroidism (maximum value of excretion in urine for HCG was 2323 fmol/mgCr). The excretion of malignant isoform of HCG in urine was 0 in benign hyperparathyroidsm and in four cases of malignant hyperparathyroidism which fell into the category of persistantly low HCG. The maximum excretion of the malignant isoform of HCG in urine was 1.8, in the category of very high HCG. Calcium and parathyroid hormone were mildly raised in benign parathyroidism, while parathyroid hormone was markedly elevated in cases of malignant hyperparathyroidism falling into the category of very high HCG. Conclusions: The excretion of urinary HCG in urine has the ability to distinguish between parathyroid adenomas and carcinomas and thus has potential to become a marker of disease progression in malignant parathyroid disease.


  1. Chapoteau E, Czech BP, Zazulak W, et al (1993). New reagent for colorimetric assay of calcium in serum. Clin Chem, 39, 1820-4.
  2. Cole LA (2012). hCG, the wonder of today's science. Reprod Biol Endocrinol, 10, 24.
  3. Cole LA, Butler SA (2008). Hyperglycosylated human chorionic gonadotropin and human chorionic gonadotropin free betasubunit: tumor markers and tumor promoters. J Reprod Med, 53, 499-512.
  4. Cole LA, Wang YX, Elliott M, et al (1988).Urinary human chorionic gonadotropin free beta-subunit and beta-core fragment: a new marker of gynecological cancers. Cancer Res, 48, 1356-60.
  5. Endres DB, Villanueva R, Sharp CF Jr, et al (1989). Measurement of parathyroid hormone. Endocrinol Metab Clin North Am, 18, 611-29.
  6. Goldfarb M, O'Neal P, Shih JL, et al (2009). Synchronous parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma in a patient with severe and long-standing hyperparathyroidism. Endocr Pract, 15, 463-8.
  7. Kebebew E, Arici C, Duh QY, et al (2001). Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg, 136, 878-85.
  8. Khan NR, Khan AN, Bashir S, et al (2012). Diagnostic utility of p63 (Ab-1) and (Ab-4) tumor markers in the squamous cell carcinomas of head and neck. Asian Pac J Cancer Prev, 13, 975-8.
  9. Raj S, Piang LK, Nair KS, et al. (2012). Awareness regarding risk factors, symptoms and treatment facilities for cancer in selected states of India. Asian Pac J Cancer Prev, 13, 4057-62.
  10. Rodriguez C, Naderi S, Hans C, et al (2012). Parathyroid carcinoma: a difficult histological diagnosis. Eur Ann Otorhinolaryngol Head Neck Dis, 129, 157-9.
  11. Rubin MR, Bilezikian JP,Birken S, et al (2008). Human chorionic gonadotropin measurements in parathyroid carcinoma. Eur J Endocrinol, 159, 469-74.
  12. Sriussadaporn S, Phoojaroenchanachai M, Ploybutr S (2007). Hypercalcemia of malignancy: a study of clinical features and relationships among circulating levels of calcium, parathyroid hormone and parathyroid hormone-related peptide. J Med Assoc Thai, 90, 663-71.
  13. Stock JL, Weintraub BD, Rosen SW, et al(1982). Human chorionic gonadotropin subunit measurement in primary hyperparathyroidism. J Clin Endocrinol Metab, 54, 57-63.
  14. Triantafillidou K, Zouloumis L, Karakinaris G, et al (2006). Brown tumors of the jaws associated with primary or secondary hyperparathyroidism. A clinical study and review of the literature. Am J Otolaryngol, 27, 281-6.
  15. Wang HF, Wang JS (2012). Research progress in potential urinary markers for the early detection, diagnosis and follow-up of human bladder cancer. Asian Pac J Cancer Prev, 13, 1723-6.

Cited by

  1. tumor suppressor gene vol.1, pp.1, 2014,