In 0.1% the pheochromocytoma is the reason of a systemic hypertension. The symptoms of a persistent or paroxysmal hypertension with headache, excessive sweating and palpitations lead in 90% to the diagnosis pheochromocytoma. Very rarely a patient with pheochromocytoma may be asymptomatic. We introduce a 68-year-old man whose pheochromocytoma primarily rose up while ESWL and furthermore in anaesthesia. The problems to determine the diagnosis will be scrutinized as following.