Phaeochromocytoma and Paraganglioma (PPGL) are relatively uncommon and clinically heterogenous neuroendocrine tumors that arise from pluripotent neural crest cells. Treatment options for unresectable or metastatic PPGL, especially for patients with uncontrolled secondary hypertension, are limited. Oncologic radionuclide treatment conventionally included the use of 131I-metaiodobenzylguanidine (MIBG) therapy for tumors demonstrating high uptake on MIBG imaging. Recently, peptide receptor radionuclide therapy (PRRT) using 177Lu or 90Y-labelled peptides have shown encouraging responses for PPGLs with high somatostatin receptor expression detected on 68Ga-labeled-peptide PET/CT imaging, as a promising option and potential alternative to MIBG theranostics. This session will provide an overview of nuclear imaging and radionuclide therapy available for patients with metastatic PPGL focusing on MIBG and somatostatin receptor targeting. We will review the current evidence, discuss its oncologic applications with case examples, address practical issues and outline potential emerging personalized approaches in patients with metastatic PPGL.