DOTANOC PET/CT revealed 52 lesions in 17 patients with elevated FGF-23 and hypophosphatemia, where 11 were highly suspicious for culprit lesions. Subsequent anatomical imaging with CT/MRI showed concordant results in 7 out of 9 patients. These lesions were excised and histologically verified PMTs. Multiple lesions make it difficult to identify the culprit lesion. The gene discussed is FGF23; the disease is hypophosphatemia.