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Metastatic malignant pheochromocytoma can be a disease of long duration and though poorly responsive to both radiation therapy and chemotherapy, pharmacologic management of its myriad manifestations can be very effective. Hypertension is the most recognized feature of this disease, but gastrointestinal manifestations can, on rare occasions, be just as serious and life threatening. We present two patients with metastatic pheochromocytoma who developed pseudo-obstruction, and discuss the pathopharmacology and treatment of this syndrome.