BACKGROUND: Pheochromocytoma is a rare adrenal medulla tumor that overproduces catecholamines, causing major cardiovascular issues. It is often found incidentally during imaging, but large tumors pose unique perioperative challenges. Patients are usually symptom-free until the tumor grows, risking an adrenergic crisis during surgery. This case underscores the complexities of managing large pheochromocytomas, highlighting the risks of unstable hemodynamics and the need for thorough preoperative planning and a multidisciplinary approach for successful surgery. CASE REPORT: We present a case of a 55-year-old Chinese man admitted for surgery after a routine exam revealed a 7.8 cm mass in his left adrenal gland. Initially asymptomatic, he was diagnosed with pheochromocytoma via blood tests and computed tomography scans. Pre-surgery, he received an α-receptor blocker. During the tumor removal, which was large and adhered to nearby vessels and tissues, he suffered an adrenergic crisis with unstable hemodynamics.We implemented emergency measures to stabilize the patient's vital signs in a rare case of large pheochromocytoma with adrenal crisis. With multidisciplinary team management, the patient recovered well post-surgery. CONCLUSION: This article discusses the disease's unique clinical features, reviews literature on the link between massive pheochromocytoma and adrenal crisis, and outlines perioperative management strategies as a reference.