This article reports a case of metastatic recurrent adrenal pheochromocytoma in a young man presenting with recurrent chest tightness and chest pain. In 2019, a right adrenal mass was detected, and laparoscopic resection of the right adrenal tumor was performed. Pathology confirmed pheochromocytoma, with a Ki-67 index of 1%-2% and positive SDH-B expression. In 2022, recurrence at the operative site with peritoneal, greater omental, and lymph node metastases was identified, and the patient underwent debulking surgery followed by cyclophosphamide, vincristine, and dacarbazine (CVD) chemotherapy. In 2025, recurrent disease at the operative site and multiple peritoneal metastases were detected again. A second debulking surgery was performed, and tumor tissue was obtained for patient-derived organoid culture. Drug sensitivity testing showed that sunitinib markedly inhibited adenosine triphosphate (ATP) activity and epinephrine secretion in the organoids. After multidisciplinary consultation on difficult cases in Guangdong Urological Association, oral targeted therapy with sunitinib at 37.5 mg/day was initiated. At the latest follow-up, the patient remained in good general condition, without chest tightness, palpitations, or other discomfort. This case suggests that the management of metastatic recurrent pheochromocytoma should not rely solely on conventionally low-risk pathological features, but should incorporate recurrence pattern, metastatic evidence, and the longitudinal disease course to assess malignant potential. In this case, MDT discussion integrated input from Urology, Radiology, Pathology, Medical Oncology, and other specialties. This collaborative approach helped establish an individualized strategy involving surgical debulking, systemic treatment selection, and long-term follow-up, thereby highlighting the important clinical value of MDT-based decision-making in complex cases.