Paragangliomas are rare neuroendocrine tumors with a high degree of inheritance. These neoplasms arise from the extra-adrenal autonomic paraganglion and can secrete catecholamines. Many patients debut with symptoms of hypertensive crisis, tachycardia, dyspnea, headache and intense sweating. However, many tumors that are derived from the parasympathetic system are asymptomatic. Supported on the genetic basis are classified into two conglomerates: conglomerate I are those that have mutations and alter the response to hypoxia. Cluster II has a more syndromatic component, with alteration in the function of complex signaling pathways. A study based on histopathological diagnoses was carried out between 2007 and 2017 at a hospital in Bogotá (Colombia) 2600 meters above sea level, which documented 108 cases of paragangliomas that were predominantly located at the carotid level (76%), with a 4.7:1 ratio between women and men. 93.2% of the patients came from geographical locations with heights above 2,500m above sea level. Most of the tumors were asymptomatic. We draw attention to the fact that paragangliomas are probably more frequent than clinically diagnosed and the influence of the environment on the development of these tumors is highlighted, with a special contribution of oxygen pressure as a second event that contributes to the formation of the tumor.