IntroductionPheochromocytoma (PCC) is a rare neuroendocrine tumor characterized by an overproduction of catecholamines (CAs), including dopamine (DA), norepinephrine (NE), and epinephrine (E). Hypertension is the most frequent cardiovascular manifestation of PCC, which can potentially progress to heart failure (HF) [1]. Clinical manifestations of PCC typically include episodic hypertension, headaches, palpitations, and profuse sweating. However, the intermittent nature of these symptoms and signs complicates timely diagnosis, making PCC susceptible to misdiagnosis or delayed diagnosis, thereby increasing the risk of adverse outcomes.Nevertheless, PCC is a treatable condition when identified and managed promptly. The measurement of blood CAs is crucial for the initial qualitative diagnosis of PCC. Once discovered, early surgical resection remains the most effective treatment. However, the possibility of metastasis persists. Patients with metastatic PCC, characterized by a higher number, larger size, and wider distribution of tumors, exhibit a lower survival rate. Regular follow-up of PCC patients is essential for monitoring the potential for metastasis and concurrent symptoms[2]. Although computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) are valuable tools for detecting distant metastasis, their limited sensitivity and high cost, coupled with the potential delay in diagnosis, pose significant challenges. Elevated levels of plasma 3-methoxytyramine (3-MT) are indicative of a higher probability of PCC metastasis and serve as a biomarker for tumor spread[2, 3]. This case report details a patient with PCC who failed to receive timely surgical intervention and rigorous follow-up, leading to metastasis and subsequent HF.