Pheochromocytoma Presenting as Stroke in Two Taiwanese Children

Pheochromocytoma is a rare tumor and accounts for about 1% of pediatric hypertension. Its diagnosis is important because the hypertension is usually curable by eradication of the tumor. We report two Taiwanese children with pheochromocytoma presenting as stroke. Patient 1 developed a cerebral infarction and patient 2 had an intracranial hemorrhage. Abdominal MRI of patient 1 showed an extraadrenal tumor 5.1 x 4 x 4.7 cm in size and abdominal CT of patient 2 revealed a left adrenal mass 4 x 2.9 x 4 cm in size. 24-h urinary excretion of norepinephrine for patients 1 and 2 were 1480.8 and 3279 microg/day, respectively. Preoperative alpha- and beta-adrenergic blockade was used for hypertension control. Both patients underwent successful tumor resection, upon which blood pressure and 24-h urinary excretion of catecholamines returned to normal without any further medication. They have been free from hypertension for 4 years (patient 1) and 2 years (patient 2).