Background <p>Takotsubo syndrome is an acute and reversible form of left ventricular dysfunction most often seen in postmenopausal women and typically triggered by extreme emotional or physical stress. Its occurrence in children is exceedingly rare. Pheochromocytoma, a catecholamine-secreting tumor, can mimic Takotsubo syndrome due to its cardiovascular effects. This case is reported for its rarity and to raise awareness of pheochromocytoma as a potentially life-threatening but reversible cause of stress cardiomyopathy in children.</p> Case presentation <p>A 7-year-old boy presented with signs of acute heart failure, including respiratory distress and hypertension. Echocardiography revealed severe left ventricular dysfunction, necessitating invasive mechanical ventilation and high-dose inotropic support. Initial cardiac magnetic resonance imaging and laboratory evaluations were inconclusive. Persistent hemodynamic instability and unexplained cardiac dysfunction prompted a multidisciplinary evaluation. Abdominal magnetic resonance imaging revealed an adrenal mass, and biochemical analysis confirmed elevated catecholamines, leading to a diagnosis of pheochromocytoma. Management included alpha-adrenergic blockade to control hypertension and correct volume status, followed by cautious initiation of beta-blockade. Despite medical therapy, the patient’s cardiac function did not improve significantly, and surgical resection of the adrenal tumor was performed on hospital day 10. Histopathological examination confirmed the diagnosis of pheochromocytoma. Postoperatively, cardiac function improved rapidly.</p> Conclusions <p>This case highlights pheochromocytoma as a rare but important differential diagnosis in pediatric patients presenting with acute heart failure and Takotsubo-like cardiomyopathy. Early recognition and targeted management can lead to complete recovery. Increased awareness among pediatricians and cardiologists is essential to avoid delayed diagnosis and improve outcomes in similar cases.</p>