Craniopharyngioma is a congenital tumor located in the saddle area. The tumor is closely related to the hypothalamic-pituitary axis, therefore, patients with craniopharyngioma often have symptoms and signs of impaired hypothalamic and pituitary function, which in turn affect the endocrine situation of patients. In adults, the common endocrine disorder is low gonadal hormone, which is manifested as impotence in men and menstrual disorder and menopause in women. Surgery is currently the preferred treatment for craniopharyngioma, but it can further affect pituitary and hypothalamic functions, exacerbating the endocrine disorder, which may be life-threatening. Most patients have varying degrees of hypothyroidism of one or more hormones (except PRL) before surgery, and the situation is further aggravated after surgery compared to the preoperative period, with insignificant recovery in the early postoperative period. Hypothyroidism is a more common endocrine symptom of craniopharyngioma, often manifested as fear of cold, poor mental appetite, dry skin, bradycardia, etc. However, due to the long metabolic cycle of thyroid hormones in the body, the recent effects of surgery are often not obvious, while TSH is significantly affected by surgery. The incidence of hypocortisolism after craniopharyngioma surgery can be 24-91%, with some authors reporting a 37% incidence of hypocortisolism after transsphenoidal surgery and a 61% incidence after craniotomy. Hypogonadotropic hormone is the most common manifestation of adult craniopharyngioma, but it is also the most neglected aspect, especially in adult male patients. However, there is no doubt that hypogonadotropic hormone can cause great harm to patients, especially in children and adolescents, resulting in delayed or even non-developmental puberty, and in young women, it may cause menstrual disorders, ovarian and uterine development disorders, infertility and other serious consequences. Serum prolactin may be elevated in 8-50% of patients, indicating hypothalamic invasion or craniopharyngioma affecting dopamine transport from the hypothalamus to the pituitary portal vessels. One of the characteristic clinical signs of craniopharyngioma is uropharyngeal avalanche, which results in the inability of the distal renal tubules and collecting ducts to reabsorb water due to the tumor affecting hypothalamic ADH production or transport, resulting in massive hypotonic urinary excretion. The impact of surgery on urothelial dysuria is obvious, as most craniopharyngiomas originate in close relationship with the pituitary stalk, and intraoperative harassment or injury to the pituitary stalk can exacerbate postoperative urothelial dysuria. The surgical approach and the extent of tumor resection have a significant impact on postoperative endocrine changes. The results showed that the proportion of hypopituitarism and uroemesis after craniotomy was significantly higher than that of transsphenoidal surgery. The reasons for this are that craniotomy is very difficult to protect the pituitary stalk, and most of craniopharyngiomas are closely related to the pituitary stalk, so it is likely that the pituitary stalk will be damaged or even severed during tumor removal, which will inevitably cause serious It is likely to damage or even sever the pituitary stalk during resection, which is bound to cause serious endocrine consequences. In contrast, transsphenoidal surgery can protect the anterior pituitary lobe at an early stage, so that the postoperative anterior pituitary function is minimized. The extent of tumor resection is also an important factor in postoperative endocrine compromise, and the chance of damaging the hypothalamic-pituitary axis during extensive and complete tumor resection is much higher. Endocrine abnormalities in craniopharyngioma are irreversible in most patients and have further exacerbated postoperatively. Adrenocortical, thyroid function, and hypogonadism seriously affect postoperative recovery and normal life, and are even life-threatening, so hormone replacement therapy should be an important part of craniopharyngioma treatment. Our experience is that patients with craniopharyngioma should undergo a comprehensive endocrine evaluation before surgery, and all patients should receive oral prednisone 15mg/d 3 days before surgery (patients with preoperative endocrine examination showing hypoadrenocorticism can start hydrocortisone supplementation 100-200mg/d 3 days before surgery), intraoperative hydrocortisone 100mg, and intravenous hydrocortisone 200-300mg/d 3 days after surgery. Three days later, the dose of prednisone should be changed to oral prednisone 15-20mg/d and gradually reduced. During this process, the indicators of blood cortisol and urinary free cortisol should be monitored, and the clinical symptoms of patients should be observed. Maintenance dose. Some patients may require lifelong hormone replacement therapy. Patients with hypothyroidism may be treated postoperatively with levothyroxine, starting at 50 μg/d and increasing to 100-200 μg/d over a few weeks, with relief of chills, poor mental health, and swelling. Because thyroid hormone alone can aggravate adrenocortical insufficiency, supplementation with cortisone hormone should be given priority before or at least simultaneously with thyroid hormone. Testosterone can be used to improve sexual function in men with low sex hormones. Androgens are also used to promote protein synthesis and improve physical and nutritional status of patients. Female patients can be treated with artificial cycles and small doses of androgens to improve sexual function and physical strength. Surgery is the treatment of choice for craniopharyngioma, and total resection of the tumor is the most important factor in reducing postoperative recurrence. Once recurrence occurs, the rate of total resection is extremely low, and the rate of postoperative death and disability is significantly higher, so total resection of the tumor is always the first consideration between preserving the patient’s endocrine function and tumor removal. The protection of hypothalamus, pituitary stalk, and pituitary gland should be emphasized during surgery to avoid unnecessary traction and forced blind resection. Endocrine replacement therapy should be actively performed.