In order to evaluate the effects of lithotripsy (ESWL) on adrenocortical hormone levels, we prospectively compared blood ACTH, cortisol, aldosterone and DHEA-S levels of patients treated by lithotripsy and with elective operative cholecystectomy for biliary stone disease. After surgery, blood cortisol and ACTH levels were increased significantly at 16 hours (p < 0.05) and returned to normal at 40 hours while in the ESWL group the aforementioned enzyme levels were elevated significantly at 16 and 40 hours after ESWL (p < 0.05). The comparison of two groups at 16 hours showed no difference (p > 0.05). DHEA-S levels were elevated significantly at 16 hours after lithotripsy (p < 0.05) but the elevations after surgery were not significant (p > 0.05). Aldosterone levels were elevated significantly in both groups (p < 0.05) but the comparison of the two groups showed no difference (p > 0.05). In conclusion, ESWL induces trauma to the neuroendocrine system and the duration of the response is longer when compared with surgical trauma.