PD31-07 CLINICAL SEVERITY OF RESECTED PHEOCHROMOCYTOMAS AND ITS RELATION TO PHEOCHROMOCYTOMA OF THE ADRENAL GLAND SCALED SCORE (PASS)

Abstract

INTRODUCTION AND OBJECTIVE: Pheochromocytomas (PCC) are tumours of the adrenal gland that are known to release catecholamines leading to severe symptoms. Although the symptoms of these tumours (elevated heart rate, high blood pressure, headache) have been described very clearly, patients can present to hospital emergently and often in crisis with life threatening symptoms. These patients can require management in the intensive care unit and prolonged hospitalization before they can undergo surgery to remove these tumours. Once removed, these symptoms will almost immediately stop. The Pheochromocytoma of the Adrenal Gland Scale Score (PASS) was developed by Dr. L. Thompson in 2002 to help identify pathologically malignant tumors. PASS ≥ 4 is thought to have the potential for malignancy, <4 is favoured to be benign. We hypothesized that higher PASS was associated with worse initial presentations prior to eventual resection. METHODS: We performed a retrospective chart review on all resected pheochromocytomas in a tertiary institution from 2008-2018. Demographics, pathology results, operative details, pre and post operative courses, and additional information was collected. Pathology slides were pulled and a PASS score was given to all specimens. A total of 64 resected pheochromocytomas were selected and reviewed. RESULTS: Of the 64 resected tumours, only 2 cases (PASS 4 and 12) were malignant with metastases found on follow-up. Average PASS was 5.4 (0-15) with the most common score being 8 (10 patients). Majority (61%, n=39) had PASS ≥4. Average size of PCC with PASS <4 and ≥4 was 4.18cm and 5.6cm respectively. ICU admission was required for 7 patients (11.3%), average PASS for ICU patients was 8.6 vs 5.1 in non-ICU patients. Eight patients had severe cardiac presentations (cardiomyopathy, hypertensive crisis, or NSTEMI) with their average PASS 3.3. Average max sBP during surgery with PASS <4 and ≥4 did not vary at 178mmHg and 183mmHg respectively. 64% of patients had symptoms prior to diagnosis (headache, hypertension, palpitations). Of patients with no symptoms, 55% had PASS ≥4. 66% of patients with symptoms had PASS ≥4. CONCLUSIONS: Higher PASS (≥4) in surgically resected PCCs did not consistently show worse presentations compared to those <4. In fact, majority of our patients had PASS ≥ 4 with only 2 cases of malignancy identified. Severe cardiac presentations were found to have low PASS. Our findings suggest the Pheochromocytoma of the Adrenal Gland Scaled Score has a limited role in relationship to the clinical severity and presentation of pheochromocytomas. Source of Funding: None