Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 06 08 1671 1671 Moojan Shabani Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. Samrand Fattah Ghazi Department of Anesthesiology and Intensive Care, Tehran University of Medical Sciences, Tehran, Iran. Morteza Daraie Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hamed Kazemi Khaledi Department of Endocrine Surgery, Tehran University of Medical Sciences, Tehran, Iran. Shahram Bagheri-Hariri Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2025 10 15 2025 12 05 Rare tumors that release catecholamines and originate in the adrenal medulla are called pheochromocytomas. They usually manifest as headaches, diaphoresis, palpitations, and hypertension, but occasionally they can resemble panic disorder. We report the case of a 51-year-old man who had dyspnea, chest pain, and a hypertensive crisis. Despite treatment with antihypertensives and anxiolytics, his symptoms persisted. Imaging revealed a large hemorrhagic adrenal mass consistent with a ruptured pheochromocytoma. Following laparoscopic adrenalectomy, histopathological analysis confirmed pheochromocytoma with a Zellballen pattern and vascular invasion but no capsular invasion. This case highlights the importance of considering secondary causes of hypertension, particularly pheochromocytoma, in patients with refractory symptoms and overlapping psychiatric features. https://fem.tums.ac.ir/index.php/fem/article/view/1671 https://fem.tums.ac.ir/index.php/fem/article/download/1671/547