A 51-year-old woman with recurrent paragangliomas and catecholamine hypersecretion underwent F-FDG PET/CT for localization and evaluation of extent of disease. This revealed multiple F-FDG avid tumors with localization pattern suggesting multiple primary neoplasms of different origin rather than disseminated paraganglioma. Three additional nuclear medicine investigations were performed (F-DOPA PET/CT, Ga-DOTATOC PET/CT and I-MIBG scintigraphy) to further characterize tumor biology, guide diagnostic workup, and decide treatment strategy. Biopsies showed benign paraganglioma, mucinous adenocarcinoma of the cecum, renal cell carcinoma, and thyroid colloid nodule. Treatment strategy was based on tumor biology determined by the various PET and SPECT tracers used.