Data and methods 1. General data: The male:female ratio in this group was 1:55, and the age of the patients ranged from 15 to 49 years old, with an average of 30.5 years. One patient had undergone gamma knife treatment twice before hospitalization and had been taking oligocryptine for 2 years. 9 patients had been treated with oligocryptine alone (3 of them had been taking it for >2 years, 6 for <1 year, 1 of them had been taking 12.sm for 4 months). 2 cases had tumor recurrence after pituitary tumor resection (ACTH adenoma and CH adenoma, respectively). The patients mostly presented with menstrual disorders, menopause, lactation, obesity, headache and dizziness as the main clinical manifestations. All patients had their serum endocrine hormones measured before hospitalization and on the 6th or 7th day after surgery by using the immunoassay method. All patients underwent preoperative MRI (flat scan with ten enhancement or dynamic enhancement) and coronal CT examination, and the MRI showed that the tumors were <10 mm, with an average diameter of 0.7 mm. 3. Tumor classification: According to clinical manifestations, plasma endocrine measurements and postoperative pathology, immunohistochemistry confirmed that 51 cases were functional adenomas, including 39 cases of PRL adenoma, 10 cases of ACTH adenoma, 1 case of mixed adenoma (PRL + ACTH), and 1 case of mixed adenoma. The patients had 1 case of mixed adenoma (PRL +ACTH), 1 case of GH adenoma, and 5 cases of non-functional adenoma. 4. Treatment: 55 patients underwent single nostril transsphenoidal pituitary tumor resection, and one patient underwent sublabial nasal and pterygoid human pituitary tumor resection due to small nostril. Results: 1. The follow-up time of this group of cases: 1 to 21 months, 2 cases were lost (1 case each of PRL adenoma and ACTH adenoma). 54 cases showed significant improvement in their original symptoms after surgery, including 23/26 (89%) cases of amenorrhea recovery, 30/32 (91%) cases of lactation cessation, 7/9 (78%) cases of menstrual flow reduction recovery, 16/l7 (94%) cases of headache and dizziness relief, 5 cases of headache and dizziness relief due to non-functional adenoma. The headache and dizziness in the 5 cases of non-functional adenoma were all relieved, and 3 of the 5 infertile patients had successfully conceived. Excluding the aforementioned 4 patients who took oligocryptine >2 years and underwent gamma knife treatment, the amenorrhea recovery rate was 24/26 (92%). 8/10 patients with Cushing’s disease had significant weight loss in the range of 5 to 15 kg, smooth skin, disappearance or fading of purple lines, and normal blood pressure. MRI review at 4 months after surgery showed no tumor recurrence (Figure 1, 2). There were 14 cases of postoperative dysuria, 11 cases recovered within weeks, 2 cases recovered within l month, and 1 case recovered within 7 months. Hypoadrenocorticism:PRL, non-functional adenoma 6/36 (14%) cases, all recovered within 3 months. AcTH adenoma 9/l1 (92%) cases, 9 cases postoperative day 7 blood cortisol are <2 lingg/dl (5 a 25 ling expansion dl), 2 cases for 2.9 ling group dl, 5 cases within 3 months back to normal, 5 cases follow-up six months still not back to normal, but taking The dose of prednisone had been significantly reduced, and 1 case was lost; 1 case of cerebrospinal fluid nasal leakage was cured after 2 surgical repairs. There were 19 cases of olfactory disturbance, 17 cases recovered within 1 month and 2 cases recovered within 4 months. One case of newly appeared amenorrhea remained unrecovered within 3 months. 2, the endocrine changes before and after surgery: 39 cases of PRL adenoma and l cases of AcTH + PRL mixed adenoma patients preoperative PRL average 137.In years ml; postoperative day 6 (day 7) 34/4O (85%) cases of patients with completely normal PRL, the average 6.sn reward resistance, 6 cases did not drop to normal in 3 cases of patients taking Binocryptine for 12, 4, 2 years, respectively, l cases The average follow-up time of 35 patients (excluding the above 5 cases) was 11.5 months, 1 case was lost, 2 cases had elevated prolactin again, which was normalized after continued treatment with small doses of oligocryptine. The rate of normalization of PRL was 32/34 (94%). 10 cases of Cushing’s disease had normal ACTH, 5 cases had normal blood cortisol or UFC, 5 cases had cortisol <5b dls, 1 case had GH25n amplified ml before surgery of cH adenoma, 4 months after surgery GH0.sn paid ml (after OCI). 3, imaging diagnosis: 50/56 patients were found to have low signal occupancy <1.ocm on MRITI-weighted images or Tl-weighted reinforcement scans, and 5 coincidentally 6 patients who were not found to have definite occupancy on plain and reinforcement scans underwent dynamic reinforcement scans on MRI, and low signal occupancy was found to be later than normal pituitary reinforcement in early reinforcement; 46/56 cases had superior pituitary bulge, with left and right asymmetry (limited bulge) in 49/56 cases, and pituitary stalk deviation in 25/56 cases. MRI is still the main means to diagnose pituitary microadenoma, and the low-signal occupancy >3mm in the saddle is diagnostic significance after scan or enhancement. /However, negative MRI findings do not exclude microadenoma, especially the diagnosis of Cushing’s disease. salenav. et al. [‘] reported 54 patients with Cushing’s disease, 28 of whom had no abnormal MRI findings, but the endocrine diagnostic indexes were met, and after surgical exploration, 28 cases pituitary microadenomas were found in 53% of the patients with negative MRI. The endocrinological diagnosis of ACTH adenoma is therefore particularly important. The literature reports that the ratio of ACTH to peripheral blood is measured by blood sampling from the sublithic sinus bilaterally to characterize and fix the side with higher specificity. In our group of 11 patients, only one case had no clear preoperative low-signal occupancy, but indirect signs (superior pituitary rim expansion) were highly suspicious of microadenoma, which was finally confirmed as ACTH adenoma by surgical exploration and immunohistochemistry. We found that prolactin microadenoma is predominantly found in females, and is more common in young females. These symptoms can be easily ignored or treated in the male department for a long time and are difficult to be detected early. The main manifestations of female prolactin microadenoma are menopause, lactation, menstrual irregularities, headache, etc. All of the laboratory prolactin is elevated, with an average of 137.In dream ml in our group, generally not more than 200 n years old mI. Therefore, the correct diagnosis of prolactin microadenoma should be a combination of clinical manifestations, endocrine laboratory and imaging findings, with pure imaging support (e.g. <3 mm low signal in pituitary) without corresponding clinical manifestations and endocrine incompatibility, it is difficult to diagnose pituitary microadenoma; whereas simple elevated prolactin without menopause or lactation and no positive MRI findings are likely to be idiopathic hyperprolactinemia. If the MRI scan and enhancement do not reveal a clear low-signal occupancy, but some indirect signs suggest the possible presence of microadenoma, it is necessary to perform further dynamic enhancement scans of MRI. Treatment of pituitary microadenoma: (1) Treatment of ACTH adenoma: Since pharmacological treatment is not very accurate, transsphenoidal surgery is the first choice after diagnosis t4]. While the tumor is completely removed during surgery, it can be removed together with a little normal pituitary tissue around it to prevent recurrence. In our group, 8 of 10 patients with ACTH microadenoma had significant weight loss after surgery, and symptoms such as purple striae, seat sores, and hypertension improved significantly. 9 cases had blood cortisol <2.0 lincoln dl on the 7th day after surgery, and 2 cases had 2.9 lincoln d1. 5 cases still needed prednisone replacement therapy after 6 months, but the dosage of prednisone was gradually decreasing. There is a recurrence rate of 10% to 30%, which varies greatly among reports and there is no uniform measure. Currently, most scholars believe that a short-term postoperative gross blood cortisol of 2.0 linden dl can achieve a cure. In conclusion, the effect of surgical treatment of ACTH adenoma has been recognized by scholars at home and abroad, with a cure rate of about 70% a 85%, and for patients with Cushing's disease without positive MRI findings, there is also a tendency to surgically explore Wan',, mouth. (2) Treatment of lactin microadenoma: For more than 20 years, due to the good control effect of dopamine receptor agonists on lactin adenoma represented by Oxytetracycline, drug therapy has been the preferred treatment for lactin adenoma, but because Oxytetracycline can only inhibit tumor growth, lactin will rebound after stopping the drug, requiring long-term or even lifelong medication, especially in recent years with the increase of Oxytetracycline resistance, and some Tumer et al. reported 32 patients with pituitary microadenoma treated by butterfly surgery, 68.7% of whom were treated with surgery because of the poor efficacy of drugs such as cryptocryptine or intolerance of its side effects, and achieved a 78% cure rate after an average follow-up of 10 years. Wolfsberger et al. "6-D surgical treatment of 46 male patients with prolactin microadenoma was followed up for 7 years, and 73% of the patients had normalized their lactogen, the authors concluded that male patients with prolactin microadenoma can be cured if they can be detected early. The authors believe that male patients with prolactin microadenoma can be cured if detected early, and many other scholars have achieved comparable or better results than drug therapy.73 In this group, 34 (85%) of the 39 patients with prolactin and 1 patient with mixed microadenoma had completely normalized prolactin at 1 week after surgery, and among the 6 patients whose PRL did not fall to normal, 3 cases were on OxyContin for 12, 4, and 2 years, 1 case was on the drug for 2 years while undergoing 2 Gamma Knife treatments, and 1 case was treated with The average follow-up was n.5 months after the exclusion of the above-mentioned 5 patients, and only 2 cases of mild rebound of prolactin were reviewed and normalized after supplemental treatment with a small dose of Oxytetracycline, with a normal PRL recovery rate of 94% and a 92% amenorrhea recovery rate. The main postoperative complication was olfactory disturbance, but it was mostly recovered within 1 month. In this group, 19 patients with olfactory disturbance occurred, only 2 cases recovered within 6 months, which was considered to be probably related to the more serious damage to the superior turbinate exenteration and its corresponding nasal septal hemidiaphragm or the local stimulation of biogel when closing the saddle base. There was one case of cerebrospinal fluid nasal leakage, and this patient had already undergone two Gamma Knife treatments and taken oligocryptine for more than 2 years before surgery. The above results fully indicate that the short-term efficacy of microadenoma surgery is remarkable, but due to the short follow-up period, its long-term efficacy remains to be further observed. As for the treatment experience before surgery, especially whether drug therapy affects the surgical effect is still controversial, most scholars believe that long-term drug therapy has an effect on the surgical effect, and its surgical cure rate can be reduced from 81% to 33%, which is attributed to the ability of drug therapy to induce fibrosis in the tumor perivascular tissues, which brings difficulties to the resection of the tumor ts Chuan, but some people hold opposing views, Turn II The reported case of pituitary microadenoma did not seem to be affected by drug treatment. Of the seven patients whose PRL did not completely drop to normal after surgery in this paper, five had a history of long-term or short-term treatment with high doses of oxytocin, and fibrous tissue was also found intraoperatively.