Progress in theranostic approaches for pheochromocytoma and paraganglioma

Pheochromocytoma (PCC) and paraganglioma (PGL), collectively termed pheochromocytoma and paraganglioma (PPGL), are rare neuroendocrine tumors arising from neural crest cells and are characterized by high genetic susceptibility and clinical heterogeneity. Their management requires precise integration of diagnosis, staging, and therapy. Nuclear medicine has become pivotal in this process through molecular targeting and functional imaging, enabling both disease characterization and targeted radionuclide therapy. Two major theranostic systems— 131 I-metaiodobenzylguanidine ( 131 I-MIBG) targeting the norepinephrine transporter (NET) and peptide receptor radionuclide therapy (PRRT) based on radiolabeled somatostatin analogs (SSA)—represent complementary approaches. Advances in molecular imaging and radionuclide therapy have refined lesion detection, treatment selection, and efficacy evaluation, establishing nuclear medicine as a cornerstone in precision theranostics for PPGL.