This is a case study of a patient 32 weeks pregnant who presented with multiple endocrine neoplasia type IIa, with severe pheochromocytoma complicated by adult respiratory distress syndrome. The patient's blood pressure was labile, with systolic variations from 50 to 230 mm Hg and tachycardia ranging from 150 to 180 beats per minute. The patient was treated with a variety of alpha- and beta-blockers whose efficacy is compared. Hemodynamic measures are compared with the clinical presentation. The importance of fluid replacement is discussed.