SSTR Expressing Tubercular Bony Lesions in a Patient with Suspected Metastatic Pheochromocytoma

We report a case of a 38-year-old male with biochemically confirmed pheochromocytoma and somatostatin receptor (STIR)-expressing adrenal and skeletal lesions. Discordant findings on functional imaging, along with lytic bone lesions, raised the suspicion of an alternate aetiology. Further evaluation revealed extra-pulmonary tuberculosis. This case highlights the diagnostic complexity in distinguishing metastatic pheochromocytoma from infectious processes such as tuberculosis, particularly in endemic regions such as India. A multimodal approach, including biochemical testing, advanced imaging, histopathology, and microbiology, was essential in reaching the final diagnosis and guiding treatment.