Pheochromocytoma is a catecholamine-secreting tumour derived from chromaffin tissue. Signs and symptoms of pheochromocytoma include paroxysmal or sustained hypertension, headache, sweating, palpitations, nausea, tremor and anxiety. Although it can be difficult to distinguish between pre-eclampsia and pheochromocytoma in pregnancy, it is important to maintain a high index of suspicion in patients with paroxysmal or sustained episodes of hypertension, severe headaches, sweating and palpitations. Symptoms may occur for the first time in pregnancy or be worsened by the pregnant state because of increased vascularity of the tumour and mechanical factors such as pressure from the enlarging uterus or fetal movements which can stimulate catecholamine secretion.4 An important distinction between pre-eclampsia and pheochromocytoma is that pre-eclampsia is associated with proteinuria and hypertension occurring after the 20th week of gestation while pheochromocytoma is rarely associated with proteinuria and may cause hypertension throughout the entire pregnancy.5 The most sensitive and specific diagnostic finding is an elevation of urinary and plasma catecholamines and their metabolites. Pregnancy does not increase urinary catecholamine levels into the diagnostic range for pheochromocytoma and ... will not confuse the diagnosis.3 Antenatal diagnosis of pheochromocytoma is essential to improve both maternal and fetal outcome. In a review of 42 cases, Harper et al.6 found an overall maternal mortality of 17% and a fetal loss of 26%.