Our small study indicates that (68)Ga-DOTATATE PET/CT is a promising diagnostic option in the multimodality approach to neuroendocrine liver metastases of unknown primary origin.

A 17-year-old adolescent boy with biochemically raised 2-hour urinary metanephrine and normetanephrine as well as CT findings of retroperitoneal soft tissue mass and bony metastases was referred for further assessment. Apart from Ga DOTATATE PET/CT evaluation, pretargeted systemic radionuclide therapy assessment with I-MIBG scintigraphy showed unusual phenomenon of MIBG superscan. Postsurgically, restaging Tc-MDP bone scintigraphy showed typical bone superscan features. The MIBG superscan was better delineated on post-I-MIBG therapy images.

Ectopic thyroid or thyroid ectopia is a rare developmental anomaly with the prevalence of 1 per 100,000-300,000 population. Even rarer, such an anomaly manifests as dual thyroid ectopia. To our best knowledge, only one case has been reported on dual thyroid ectopia with Graves' disease in the English literature. We present here a case of dual thyroid ectopia complicated by Graves' disease, whereby the diagnosis was rendered through judicious use of various diagnostic modalities coupled with a close clinical follow-up. In this case, therapeutic consideration should be personalized with proper informed consent of the patient.

We described a case of 51-year-old female patient presented with a right calf necrotising fasciitis (NF) where osteomyelitis (OM) was suspected. 99mTc-hydroxymethane diphosphonate three-phase bone scintigraphy and 99mTc-besilosomab scan failed to demonstrate classical features of OM. The final diagnosis was only made by isolating Acinetobacter sp. in both intra-operative bone and tissue cultures from below-knee amputation. As conclusions, the detection of lower limb OM by 99mTc-besilosomab scan is not easy when there is concurrence overlying NF. The unusual three-phase bone scan finding of pericortical accumulation of tracer as an early sign of OM is highlighted in this case.

BACKGROUND : Most metastatic pheochromocytoma (PCC) and paraganglioma (PGL) express somatostatin receptors (SSTR) similar to neuroendocrine tumors, which may benefit from peptide radionuclide receptor therapy (PRRT), a molecular targeted therapy to SSTR avid tumors. We describe 5 cases of progressive metastatic PCC/PGL who had PRRT from year 2015 to 2018. RESULTS: The patients were aged 18-51 years at diagnosis of PCC/PGL, with mean duration of disease to PRRT of 9.6 (4 - 19) years. Four patients with functional disease were on alpha-blockade prior to PRRT. All patients had surgery as first line therapy, with 3 had repeated surgeries prior to PRRT. One patient had trans-arterial chemo-embolization and one patient had alcohol ablation therapy prior PRRT. All patients underwent induction treatment of PRRT, consisting 4 cycles of Lu-177 DOTATATE given at 8-16 weeks apart, with dose ranged 68.8 - 207mCi (2.5 - 7.66 GBq). Two patients with functioning PCC/PGL experienced paroxysm during PRRT, requiring adjustment of infusion rate and anti-hypertensives. Three patients had partial response and the other 2 had mixed response at interim imaging assessment. The subsequent imaging post PRRT showed stable disease. One patient had transient worsening of disease clinically and biochemically at the treatment interim which improved with subsequent cycles of therapy. All patients with functioning disease showed improvement in symptoms and catecholamine levels upon completion of PRRT, of which, 2 of them had their antihypertensive agents stopped. CONCLUSION: PRRT helps in disease control in particularly the symptoms, blood pressure and biochemical parameters in patients with SSTR avid metastatic PCC/PGL. Further review required for long term outcome of PRRT. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.