Dual FDG and Octreotide PET/CT Imaging in a Patient With Malignant Pheochromocytoma and VHL Gene Mutation

A 59-year-old woman with a history of recurrent pheochromocytoma underwent 18F-FDG and 18F-octreotide PET/CT to evaluate metastatic disease following progression on targeted therapy. FDG PET/CT showed intense uptake in a mass in the right adrenal bed, bones, lung nodules, and lymph nodes. Octreotide PET/CT confirmed concordant high uptake in the corresponding lesions. Germline testing revealed a VHL p.Asp126Asn mutation. This "dual-tracer" strategy provided complementary information on glucose metabolism and somatostatin receptor expression, facilitating prognostic stratification and therapeutic decision-making in VHL-mutated pheochromocytoma.