Pheochromocytoma can have highly variable clinical manifestations. Dilated cardiomyopathy is a serious expression, as it is life-threatening. Anesthesia in this case is delicate, and it is essential to assess the impact of hypertension on cardiac function. Intra-operatively, catecholaminergic storms can affect vital functions, and must be constantly monitored for hemodynamic effects. The main complications are hemodynamic in nature, and are governed by the timing of the operation, with adrenergic cardiomyopathy exacerbating them. Post-operative catecholamine withdrawal can be poorly tolerated. Pheochromocytoma cardiomyopathy usually evolves favorably, with full recovery of cardiac function as soon as catecholamine therapy is stopped by removal of the tumor.