A 56-year-old female with history of gastroesophageal reflux disease presented with eight weeks history of epigastric pain. Initial laboratory studies revealed mild liver dysfunction. Abdominal MRI showed multiple T2 hyperintensity liver lesion scattered throughout both hemi-liver. Laparoscopic left hepatic lobe metastasectomy demonstrated a well-differentiated, grade 3 metastatic pancreatic neuroendocrine tumour (pNET). PET imaging revealed DOTATATE- and FDG-avid pancreatic tail primary and liver metastatic disease. Given relatively asymptomatic and low-volume metastatic disease, she was commenced on Lanreotide and chemotherapy. Unfortunately, she had disease progression on somatostatin analogue and two cycles of cytotoxic chemotherapy. After discussion with multidisciplinary teams, the decision was made to proceed with peptide receptor radionuclide therapy (PRRT). Five days following her first cycle of PRRT, she presented to hospital with rapid weight gain 6kgs, facial rounding, upper body oedema and easing bruising. Biochemistry revealed elevated early morning cortisol with elevated ACTH and 24hour urinary free cortisol. She was newly hypokalemic at presentation and her cortisol did not suppress on a low or high dose dexamethasone suppression test. The timing in relation to PRRT making it suspicious for a likely diagnosis following PRRT. The course of disease and its associated management plan will be discussed in this presentation.