HYPERTENSION of long duration and serious degree is seldom encountered in pediatric practice, but when it does occur it may offer a most fascinating problem in differential diagnosis. Most cases are due to renal disease, others to coarctation of the aorta, acrodynia, lead poisoning, Cushing's syndrome, hyperthyroidism and rare types of brain tumor involving the hypothalamus. A few cases, by elimination, have to be labeled "essential hypertension," but only after thorough study has failed to reveal the cause.
For most cases of hypertension there is no effective therapy. But there is one further group, illustrated by the 3 cases to be reported here, in which surgical intervention may effect the immediate cure of an otherwise progressive and fatal hypertension. These are the cases due to pheochromocytoma or paraganglioma—tumors of chromaffin tissue which secrete epinephrine. Such tumors usually arise from the adrenal medulla (where they are called "pheochromocytoma"), but occasionally develop