Abstract
A woman in her late 70s with known left-sided phaeochromocytoma presented with acute variceal bleeding secondary to suspected cirrhosis. Terlipressin, a standard first-line vasoactive agent, was contraindicated due to the risk of precipitating hypertensive crisis. Octreotide was successfully used as the preferred alternative, combined with careful alpha-blockade optimisation and endoscopic variceal ligation, achieving complete haemorrhage control without cardiovascular complications. This case highlights the need to recognise contraindications in patients with rare comorbidities and offers guidance on selecting vasoactive agents when standard treatments pose risks.