Case Report: The silent giant: biochemical-clinical dissociation in a large cystic pheochromocytoma

This suggests a multifactorial mechanism involving cystic sequestration and biochemical alterations associated with SDHB deficiency. Clinicians must recognize that biochemistry, not symptoms, dictates management. Mandatory preoperative α-blockade remains the cornerstone for preventing lethal intraoperative hemodynamic crises in these "silent" yet biochemically active tumors.