In clinical work, we often encounter young patients with pituitary adenoma who are unmarried or do not have children yet. These patients themselves or their relatives are often very concerned about whether the pituitary function can be restored to normal and whether they can have children in the future. Here I would like to offer some insights, please understand if they are inappropriate. Pituitary adenomas are benign tumors, but not all pituitary adenomas have such friendly biological behavior. A subset of pituitary adenomas are atypical pituitary adenomas that grow aggressively at the onset, with active tumor proliferation, often with a proliferation index of 3% or more. For this kind of pituitary adenoma, it is difficult to preserve the pituitary function, and the treatment can only be aimed at preserving the patient’s vision or life, in which a combination of surgery and radiotherapy or even chemotherapy is used, otherwise the patient may pay a greater price. Li Guilin, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University The following is a patient I just discharged from the hospital, male, 22 years old, with pituitary adenoma found for 5 years, during which he has undergone 1 craniotomy, 1 r-knife treatment, and 2 transnasal butterfly surgeries (all the above treatments were performed in top neurosurgery centers in China or by very famous neurosurgeons). Before the Spring Festival the patient’s vision had dropped to 0.02 in the right eye and was at 0.1 in the left eye with extremely reduced visual field. The whole pituitary gland was hypofunctional. Therefore this patient had to undergo surgery for the 4th time, open for optic nerve decompression, with no further postoperative visual acuity loss. Pathology suggested active tumor proliferation. This patient still needs to receive high dose radiation therapy as the next step. If the tumor remains uncontrolled only chemotherapy will be administered at future follow-up. Therefore, we hope that patients with pituitary adenoma and doctors who treat pituitary adenoma should be alert to the fact that some pituitary adenoma biology is not friendly and the primary goal of treatment is to preserve life and vision, followed by endocrine function and, to a lesser extent, aesthetics. Here are the MRI films of this patient before and after this surgery Pre-operative MRI Post-operative MRI. As a neurosurgeon who is engaged in the treatment of pituitary adenoma, I also feel very helpless in front of this atypical pituitary adenoma and can only silently wish God to bless this young man.