Preoperative Adrenal Artery Embolization in a Pediatric Patient with Bilateral Pheochromocytomas: A Case Report

Pheochromocytomas in pediatric patients pose significant perioperative risks due to catecholamine-induced hemodynamic instability, and preoperative arterial embolization has been proposed as an adjunctive strategy to reduce surgical risk; however, experience in bilateral pediatric cases remains limited. We describe the case of a 12-year-old male with incidentally detected bilateral pheochromocytomas measuring 5.0 cm (right) and 3.0 cm (left) and markedly elevated 24-hour urinary metanephrines (24,150 μg/24 hours). After adequate pharmacologic preparation with alpha- and beta-adrenergic blockade, the patient underwent bilateral preoperative transarterial adrenal artery embolization using calibrated microspheres, detachable microcoils, and a liquid embolic agent, achieving near-complete devascularization of both glands. Despite pre-procedure preparation, hypertensive crises occurred during angiography; however, the staged laparoscopic bilateral adrenalectomy was completed with fewer and less severe intraoperative hemodynamic events than anticipated. The postoperative course was uneventful, with discharge on postoperative day seven and initiation of lifelong glucocorticoid and mineralocorticoid replacement therapy. Preoperative transarterial adrenal embolization may serve as a valuable adjunct in the multidisciplinary management of pediatric patients with large or bilateral pheochromocytomas to reduce intraoperative hemodynamic instability, and this technique warrants further investigation to define optimal patient selection, technical approaches, and long-term oncologic and endocrine outcomes.