Elevated human chorionic gonadotrophin levels outside of pregnancy: a screening algorithm

Key content Elevated human chorionic gonadotrophin (hCG) levels can originate from various conditions outside of pregnancy. Phantom hCG cases represent false‐positive results. Elevated pituitary‐hCG levels are a normal physiological response in women with reduced ovarian reserve. Elevated hCG levels can be present in malignancies from trophoblastic diseases, germ cell and other extra‐ovarian tumours. Learning objectives To highlight the different conditions that raise hCG levels outside of pregnancy. To clarify when to suspect physiological conditions versus malignancy. To guide clinicians on management and patient follow‐up. Ethical issues Should perimenopausal women receive routine hCG testing? How can an incorrect diagnosis of elevated hCG impact patients, particularly patients with subfertility or misdiagnosed malignancies? How does centralised management of gestational trophoblastic diseases affect patients' experience and the local centres?