Weibel-Palade bodies (WPB) are endothelial vesicles that store von Willebrand factor (vWF), involved in the early phase of hemostasis. In the present study we investigated the morphodynamics of single WPB plasma membrane fusion events upon hypoxic stimulation by using atomic force microscopy (AFM). Simultaneously, we measured vWF release from endothelial cells to functionally confirm WPB exocytosis. Exposing human endothelial cells to hypoxia (pO2 = 5 mm Hg) we found an acute (within minutes) release of vWF. Despite acute vWF release, potential cellular modulators of secretion, such as intracellular pH and cell volume, remained unchanged. We only detected a slight instantaneous increase of cytosolic Ca2+ concentration. Although overall cell morphology remained virtually unchanged, high resolution AFM images of hypoxic endothelial cells disclosed secretion pores, most likely the loci of WPB exocytosis on luminal plasma membrane. We conclude that short-term hypoxia barely alters overall cell morphology and intracellular milieu. However, at nanometer scale, hypoxia instantaneously switches the smooth luminal plasma membrane to a rough activated cell surface, covered with secretion pores that release vWF to the luminal cell surface.