In all modern implementations that I know of, pointers are effectively ints. But the formal definition of the C language takes great care in not saying that, allowing for implementation to chose how to implement pointers. In some older systems, for example in 16-bit MS-DOS with "high memory", pointers were not really ints, but pairs of ints (called the segment and the offset, if I recall correctly) whose mapping to memory positions was overlapping, i.e., non unique, you could have very different representations for the same memory position. I guess the gcc port to MSDOS by DJ Delorie had to deal with these issues somehow.

But it is possible to imagine completely exotic CPU architectures, where there is a separate type of register that can only be used for pointers and it is impossible to convert to int; you could still write C compilers for that architecture and be 100% conforming to the standard.