From 1975 through 1987, 54 patients underwent operations for pheochromocytoma (PCC): 37 patients for sporadic unilateral adrenal PCC, 9 for bilateral and familial PCC, and 4 patients for paraganglioma. In 4 additional patients, laparotomy failed to discover the reason for hypercatecholaminemia. There were no operative mortality and a low morbidity for unilateral (n = 43) as well as for bilateral adrenalectomy (n = 6). To avoid hormone replacement therapy after bilateral total adrenalectomy at least for some years, unilateral instead of bilateral adrenalectomy was preferred to be the initial surgical procedure of choice for familial and MEN-IIA-associated unilateral adrenal PCC. Autologous transplantation of the adrenal cortex were performed in 2 patients after bilateral adrenalectomy. 6 months postoperatively, the transplants were vital as proved by light-microscopy, but sufficiently functioning only in 1 patient.