A retrospective analysis of 61 patients operated upon sporadic and familial pheochromocytomas demonstrates the changes in diagnosis and therapy. Familial pheochromocytomas make up for 28% of all patients and in 13% tumor malignancy was diagnosed. Patients had suffered from endocrine crises in 21% preoperatively but only in 3% intra- and postoperatively. CT was confirmed to visualize more tumors than US or MIBG (> 90%) preoperatively. Operative strategy was based on tumor-size and tumor-localization but increasing importance of endoscopic procedures is conceded. Postoperative complications are rare (infection 8%; Addison's crisis 5%) and life threatening complications (bleeding, post op death) as well as tumor persistence or recurrence almost exclusively occur in patients with malignant disease. Altogether the main changes are the early diagnosis of especially familial disease and the use of endoscopic procedures in the treatment of patients with small benign pheochromocytomas.