Background: We describe the peri-operative challenges and anaesthetic management of a 36-year-old woman diagnosed with functioning paraganglioma and pre-eclampsia on a background of chronic hypertension, presenting with a twin pregnancy after in-vitro fertilization. Due to its rarity, management is often based on case studies and expert opinion. Case Report: This patient presents both diagnostic and management challenge, and it highlights the importance of considering overlapping pathologies in a patient with resistant hypertension. Furthermore, management of preeclampsia and catecholamine-secreting tumors may contradict each other and hence demand a multidisciplinary approach with obstetricians, endocrinologists and intensivists. Conclusion: The primary goals of catecholamine-secreting tumors and preeclampsia in pregnancy are early diagnosis and avoiding anticipated sympathetic surge.