The source of circulating progesterone and 17 -hydroxyprogesterone in hydatidiform mole

The source of the large amounts of circulating progesterone and the smaller quantities of 17α-hydroxyprogesterone in Hydatidiform Mole was studied by measuring progesterone, 17α-hydroxyprogesterone and 20α-hydroxyprogesterone in petroleum ether extracts of mole vesicle fluid and theca lutein cyst fluid following chromatography. The progesterone concentration in 10 samples of mole vesicle fluid ranged from 261–1493 ng/ml (mean 724 ng/ml) and was 8.6 times higher than the concentration in the serum. The chromatogram of the theca lutein cyst fluid showed a large peak of progesterone followed by two large secondary peaks of 20α-hydroxyprogesterone and 17α-hydroxyprogesterone. In 3 patients with benign Hydatidiform Mole, progesterone and human chorionic gonadotrophin rapidly decreased during the first 48 hours following evacuation of the mole. Thereafter, progesterone disappeared from the serum before HCG in one case, together with HCG in the second, and remained at low concentrations for 3 months in the third patient despite negative (below 0.6 IU/ml) HCG assays. The studies show that the mole trophoblast is the principal source of progesterone and the ovaries are a secondary source. Theca lutein cysts are the principal source of 17α-hydroxyprogesterone.

Serum progesterone and serum chorionic gonadotrophin in hydatidiform mole and choriocarcinoma

Progesterone and human chorionic gonadotrophin (HCG) were measured in the sera of 25 patients with hydatidiform mole, 10 patients with choriocarcinoma and 200 normal pregnancies by a competitive protein-binding assay and a haemagglutination-inhibition assay respectively. Elution of the petroleum ether extract of mole serum on Sephadex LH-20 showed that the main fraction (92.8%) was progesterone, followed by a small peak of 20 α-hydroxyprogesterone. In 21 intact hydatidiform moles, the mean serum progesterone of 106.0 ng/ml (range 17.8–263 ng/ml) was higher than for normal pregnancy. Serum HCG (mean 833 IU/ml) was similarly elevated. Low concentrations of progesterone (0–17.3 ng/ml) and HCG (15–160 IU/ml) were present in 4 patients who had aborted. The mean serum progesterone was not further elevated in patients with theca lutein cysts of the ovary. There was no correlation between the serum progesterone and the uterine size, serum HCG or malignant sequelae. In 10 cases of choriocarcinoma, the serum progesterone ranged from 1.3–61 ng/ml (mean 16.9 ng/ml), the serum HCG from 0–960 IU/ml (mean 158 IU/ml) but there was no correlation between the two values. The evidence suggests a hyperactive steroidogenesis in hydatidiform mole and poor steroidogenesis in choriocarcinoma. An HCG secretion occurs in both cases.