Systemic Radiopharmaceutical Therapy of Pheochromocytoma and Paraganglioma

Clinical features of pheochromocytoma and paraganglioma are presented, including symptoms, management options, imaging findings, and the role of genetic and hormonal biomarkers. Additionally, radiopharmaceutical agents for treatment of metastatic or inoperable disease are explored.

Course ID: Q00715 Category:
Modalities: ,


Satisfaction Guarantee


Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Nuclear Medicine Technology: 2.00
Procedures: 2.00
Endocrine and Oncology Procedures: 2.00


  1. Introduction
  2. General Considerations for Systemic RPT in Pheochromocytoma and Paraganglioma
  3. Patient Preparation Before RPT
  4. Post-RPT Radiation Protection
  5. 131I-MIBG Therapy
    1. 131I-MIBG production
    2. Patient Selection and Preparation for 131I-MIBG RPT
    3. 131I-MIBG Administration
    4. Clinical Experience with 131I-MIBG in Pheochromocytoma and Paraganglioma
    5. Dosimetric Scans
    6. Side Effects and Toxicity Profile
    7. Summary
  6. PRRT with Radiolabeled Somatostatin Analogs
    1. Patient Selection and Preparation
    2. PRRT Administration
    3. Clinical Experience with PRRT in Pheochromocytoma and Paraganglioma
    4. Dosimetry
    5. Response Evaluation with PRRT
    6. Side Effects and Toxicity Profile
    7. Summary
  7. Conclusion


Upon completion of this course, students will:

  1. identify characteristics associated with pheochromocytoma
  2. understand what tumors of sympathetic origin secrete
  3. identify which radiopharmaceutical comes in HSA or LSA options
  4. list variables that contribute to the survival rate of pheochromocytoma and paraganglioma
  5. identify the FDA approved radiopharmaceutical for pheochromocytoma and paraganglioma
  6. list medications used for catecholamine blockade prior to treatment
  7. understand the NRC regulations that allows treatment on an outpatient basis
  8. list the characteristics associated with 131I-MIBG
  9. describe preparations with high mass MIBG that can cause pharmacologic effects
  10. identify the patient screening tests needed prior to 131I-MIBG treatment
  11. identify the recommended HSA 131I-MIBG dose based on patient weight
  12. understand the dosimetry infusion rates with HSA 131I-MIBG
  13. understand the dose ranges for LSA 131I-MIBG
  14. understand LSA 131I-MIBG doses and organ toxicity
  15. list the criteria for an outpatient treatment of LSA 131I-MIBG
  16. identify variables associated with LSA 131I-MIBG infusion
  17. describe the LSA 131I-MIBG treatment schedule for metastatic pheochromocytoma bone lesions
  18. understand the biochemical response associated with HSA 131I-MIBG therapy
  19. list functional imaging options following RPT to evaluate treatment response
  20. describe when whole body dosimetry imaging is performed following 131I-MIBG
  21. identify the most common adverse side effect following HSA 131I-MIBG therapy
  22. understand how gastrointestinal toxicity is handled following LSA or HSA 131I-MIBG therapy
  23. understand the steps required for patient eligibility and 131I-MIBG
  24. list the current somatostatin imaging agents available
  25. explain the dose limiting organs affected by PRRT
  26. describe when amino acid pre treatment is administered prior to 177Lu-DOTATATE
  27. identify the FDA approved radiopharmaceutical for NET therapy
  28. list imaging modalities used for disease regression following PRRT
  29. understand renal absorbed dose toxicity limits with PRRT
  30. describe the current accepted dose protocol for PRRT
  31. describe changes that are frequently used to evaluate treatment response to PRRT
  32. describe the higher risks patients with pheochromocytoma or paraganglioma may incur following PRRT
  33. identify hematologic side effects following PRRT
  34. identify the radiopharmaceutical for pheochromocytoma and paraganglioma recommended by the National Comprehensive Cancer Network
  35. identify other considerations necessary prior to PRRT or 131I-MIBG therapy