A 51-year-old man with known pheochromocytoma refused surgical treatment over several years and subsequently presented in catecholamine crisis with shock and multiple organ failure. Laboratory testing revealed liver failure with elevated liver enzymes and coagulation abnormalities, and imaging showed ischemia of extended parts of the right liver lobe. It also revealed a large thrombus in the right portal vein, which together with severe arterial vasoconstriction impaired the dual blood supply of the liver. The patient recovered after effective medical treatment and finally underwent surgical tumor resection. Thereafter, antihypertensive treatment could be stopped. We present this exceptional case of adrenal crisis and discuss the mechanisms leading to liver failure in general and portal vein thrombosis in particular.