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Figure 20. Anterior and posterior 111In-pentetreotide images in a patient with an insulinoma. This post-treatment scan shows persistent extensive hepatic metastases.

131I-mIBG may be used to evaluate these patients but clinical accuracy is reduced because of technical factors, and small or subtle lesions will be missed; it is not recommended if 123I-mIBG is available.

Pheochromocytoma

Pheochromocytoma is a rare tumor of the sympathetic nervous system which produces characteristic symptoms of headache, sweating, diaphoresis and palpitations caused by catecholamine overproduction. Usually they present as unilateral intra-adrenal tumors, but bilateral tumors, extra-adrenal or pediatric presentations and metastatic spread occur in about 10% of patients. The diagnostic screening tool is measurement of urinary catecholamines or metanephrines while CT or ultrasound will define the presence of a mass.

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