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Following adrenal vein ligation, profound hypotension ensued, requiring transient noradrenaline infusion to maintain adequate mean arterial pressure. Histopathology confirmed phaeochromocytoma, with positive synaptophysin and chromogranin A staining. This case underscores the potential for biochemically and clinically silent phaeochromocytomas and explores possible reasons for false-negative biochemical results. Intraoperative haemodynamic instability during adrenal manipulation should raise suspicion of catecholamine secretion, even in the absence of classical symptoms. The report emphasises the importance of invasive monitoring and anaesthetic preparedness to manage unexpected catecholamine release.<\/jats:p>","DOI":"10.1136\/bcr-2025-270306","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:24:28Z","timestamp":1770737068000},"page":"e270306","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Unanticipated intraoperative haemodynamic challenges during adrenalectomy for a phaeochromocytoma misdiagnosed as an adrenocortical tumour"],"prefix":"10.1136","volume":"19","author":[{"given":"Sripriya","family":"R","sequence":"first","affiliation":[{"name":"Anesthesiology, AIIMS Mangalagiri, Vijayawada, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priyanga","family":"Sivakumar","sequence":"additional","affiliation":[{"name":"AIIMS Mangalagiri, Mangalagiri, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5393-4486","authenticated-orcid":false,"given":"Rohini","family":"Dattatri","sequence":"additional","affiliation":[{"name":"Trauma and Emergency, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thrylokya","family":"Sankar","sequence":"additional","affiliation":[{"name":"AIIMS Mangalagiri, Mangalagiri, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallikarjun","family":"Gunjigavi","sequence":"additional","affiliation":[{"name":"AIIMS Mangalagiri, Mangalagiri, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9563-6874","authenticated-orcid":false,"given":"Suresh","family":"Vaikkakara","sequence":"additional","affiliation":[{"name":"AIIMS Mangalagiri, Mangalagiri, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"2026021023551030000_19.2.e270306.1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000002438"},{"key":"2026021023551030000_19.2.e270306.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1498"},{"key":"2026021023551030000_19.2.e270306.3","doi-asserted-by":"crossref","first-page":"E267","DOI":"10.5489\/cuaj.132","article-title":"A case of clinically silent giant right pheochromocytoma and review of literature","volume":"6","author":"Li","year":"2012","journal-title":"Can Urol Assoc J"},{"key":"2026021023551030000_19.2.e270306.4","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.2.1.59"},{"key":"2026021023551030000_19.2.e270306.5","unstructured":"Bland KI , ed. 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