Login to Access Video or Poster Abstract: MP37-20
Sources of Funding: none

Introduction

Pheochromocytoma (PC) may present in a wide variety of clinical scenarios, including asymptomatic patients found to have an adrenal incidentaloma, to the critically ill patient in hypertensive crisis. No clinical classification scheme exists for PC that stratifies patients into different risk groups. We proposed and evaluated a severity classification scale for PC.

Methods

We evaluated 25 patients from two institutions who underwent adrenalectomy for PC from 2000-2015. We classified patients as follows: Class I: asymptomatic and normotensive; Class II: asymptomatic + controlled hypertension; Class III: symptomatic + controlled hypertension; Class IV: uncontrolled hypertension or hemodynamic crisis. We obtained all available pre-operative, normalized metabolic, clinical data, imaging studies, pathology (including PASS), and discharge information. Non-parametric regression and analysis of variance (ANOVA) were used for statistical considerations._x000D_ _x000D_

Results

A total of 25 patients with 26 PCs were included in our study including 3 children (11%). About half of patients were asymptomatic. Most (83%) tumors enhanced on T2 MRI. There was no difference in age, gender, or BMI between the 4 groups. About 2/3 of all patients in the study had right sided lesions. Sixty-four percent underwent laparoscopic excision. From Class I to IV, patients experienced longer ICU (R2=0.39) and overall hospital stays (R2= 0.32), and worsening pathologic features (i.e. PASS , R2=0.22). From Class I to III, urinary and plasma catecholamine levels, intraoperative blood loss and operative time, and average tumor size increased. We found that Class IV cases did not have, on average, the highest metabolic abnormalities, more complications, or larger tumor sizes in the study even compared to some Class I patients._x000D_ _x000D_ _x000D_

Conclusions

We present to our knowledge the first clinical severity scale for patients who present with PC. The I-IV scale correlated well with length of ICU and hospital stay and with pathologic findings while increasing catecholamine levels were seen comparing Class I to III. Class IV patients may represent a unique subset. Although Class IV patients did experience longer hospital stays and had higher PASS scores, multiple variables may be contributory to their critical hemodynamic collapse other than catecholamine excess alone. More research is needed to validate this scale._x000D_ _x000D_

Funding

none