Gary Olsen (LosHuertos)

Human beings like Gaiman are able condense a complex concept into an intuitive, concise package. LLMs expand simple ideas into pedantic fluff. This is not the future we want. – at Kirkland, WA

Not looking for medical advice, just for relevant case studies or recommendations as to whether or not I am being overly paranoid here.

I acknowledge that the chance that this is cancer are low, but the consequences are serious if it is cancer and if diagnosis is delayed. His physicians have refused to contact the lab to request serial dilution for his most recent hCG sample.

hCG test is also labeled as "total hCG, pregnancy" and does not list the assay used. Physician explained it as a medical billing concern, which seems like BS. No assay is approved for oncology use but some are more accurate than others.

I am concerned there is a some chance that he is experiencing early metastatic spread of burnt out choriocarcinoma, and that his subsequent (after 14d) hCG tests are due to hook effect. Nobody has attempted to explain his initial hCG result nor his persistently high E2.

He is thin and has normal SHBG. Increase of E2 to baseline w/ return of gyno while prolactin remains normal suggests prolactin-based stimulation of breast tissue was not the cause of his gyno.

I am concerned his initial presentation was pituitary hyperplasia due to lactotroph stimulation by persistently elevated E2, rather than prolactinoma. Current normal T (451) and E2 (70) despite very low LH/FSH suggest something else is stimulating Leydig cells.

Mildly elevated RBC, hematocrit, hemoglobin prompted his physician to suspect polycythemia vera. EPO was normal.

I cautioned him to get US ASAP (instead of waiting a week) and that if US was clear, to request mediastinal and retroperitoneal CT. US was clear; in response to request, endo ordered neck-down CT, which was clear. Two subsequent re-tests of hCG came back undetectable.