Angiogenesis, the formation of new blood vessels from pre-existing ones, is a fundamental process in life, being also significantly important in several pathological situations. Pleiotrophin is a heparin-binding growth factor with pleiotrophic actions and significant role(s) in the formation of new blood vessels, being regulated by angiogenic stimuli and acting directly on endothelial cells. In this minireview, we summarize data on the regulation and mode of action of pleiotrophin and its involvement in physiological and tumor angiogenesis.