Clinical manifestations: centripetal obesity, full-moon face, buffalo back, polycythemia, purple lines on the skin of the abdomen and thighs, and increased fine hair. In severe cases, amenorrhea, loss of libido, general weakness, and even bedridden. Some patients also have hypertension and diabetes mellitus. Adrenocorticotropic hormone adenoma-ACTH adenoma (Cushing’s disease): It is characterized by Cushing’s syndrome, with obesity and full-moon face. The diagnosis of Cushing’s disease requires differentiation from ectopic ACTH hyperplasia, adrenal tumors, and physiologic obesity. ACTH hyperplasia can cause many reactions in the patient’s body and can seriously affect the patient’s quality of life and health. The preferred treatment for ACTH adenoma is surgery, there is no clear and effective drug treatment, and gamma knife is only used as a postoperative residual complementary treatment. The main goal of surgery is to remove the tumor as completely as possible and lower the ACTH value to normal. Indicators of cure: No residual tumor on MRI review, normal range of ACTH review. The main manifestation is pituitary ACTH-dependent Cushing’s syndrome, the average duration of the disease is 3-4 years, mostly in young adults, more women than men. (1) Fat metabolism disorder and distribution abnormalities: obvious centripetal obesity, full moon face, buffalo back, supraclavicular fat pad, and relatively thin limbs. (2) Abnormal protein metabolism: catabolism is greater than anabolic metabolism, resulting in thin skin, dilated capillaries, polycythemia, and purple lines on the skin. Muscle weakness, muscle atrophy, incision not easy to heal, hetero-infection. Osteoporosis, low back throbbing pain, prone to pathological fractures. (3) Abnormal glucose metabolism: leads to abnormal glucose tolerance ( 75%) and diabetes mellitus (8-10%). (4) Disorders of water-electrolyte metabolism: hypokalemia, hypochlorhydria, hypernatremia, and in severe cases, hypokalemic alkalosis, requiring emergency treatment. Water and sodium retention can lead to hypertension, the incidence is 80%-90%. (5) gonadal function: excessive cortisol inhibits pituitary gonadotropin, 71%-87% of female patients have centripetal obesity, full-moon face, buffalo back, polycythemia, purple lines on the skin of abdomen and thighs, and an increase in fine hair. In severe cases, amenorrhea, loss of libido, general weakness, and even bedridden. Some patients also have hypertension and diabetes mellitus. About 20% of male patients have decreased libido, impotence, reduced spermatozoa, and testicular atrophy. Secondary increase in adrenocortical male hormones can lead to acne (mostly on the face and chest and back), increased female hairs, beard growth, and enlarged throat nodes. (6) Other manifestations: Some patients have mental abnormalities, with depression being more common. Pre-pubertal onset can seriously affect growth and development. Late onset patients often die due to complications of cardiovascular and cerebrovascular diseases, respiratory diseases and infectious diseases. Surgical treatment: Once the diagnosis of Cushing’s disease is established, the ideal treatment of choice to achieve a cure without causing permanent adrenal and pituitary insufficiency is transsphenoidal microsurgical excision of pituitary ACTH adenomas, which are mostly buried in the pituitary gland. In addition to resecting the tumor, the pituitary gland should also be resected. In addition to resection of the tumor, a major excision of the peritubular pituitary tissue should be performed (in adolescent and fertile adults), or a subtotal excision (in non-fertile adults), which can improve the surgical outcome. If no lesion is found on exploration, subtotal pituitary resection should be performed rather than readily performing total pituitary resection. The overall cure rate of Cushing’s disease is reported in the literature to be between 74% and 84%. The cure remission rate of Cushing’s disease in our hospital is 88.7%, including 91.7% for ACTH adenoma, 72% for ACTH cell hyperplasia, and 80% for those without adenoma and hyperplasia. The efficacy of different resection methods varied, with the cure remission rate of 95.9% for subtotal resection of tumor plus peritumoral pituitary tissue, 86.7% for major peritumoral pituitary resection, and 80% for selective resection of tumor alone. In most patients, cortisol rapidly decreased to normal or below normal about 1 week after surgery, and the level of cortisol within 1 week after surgery was consistent with that of 3-6 months after surgery. Recovery in those with postoperative symptoms of hypocortisolism takes 3 to 12 months. The recurrence rate of pituitary ACTH adenoma after surgery ranges from 6% to 25%. For those who are not in remission or have recurrence and are still pituitary in origin, re-exploration of the pituitary gland via the pterygoid gland and total pituitary resection should be preferred. Radiotherapy, adrenalectomy or drug therapy can also be chosen according to the specific situation. Clinical manifestations: centripetal obesity, full-moon face, buffalo back, polycythemia, purple lines on the skin of the abdomen and thighs, and an increase in fine hair. In severe cases, amenorrhea, loss of libido, general weakness, and even bedridden. Some patients also have hypertension and diabetes mellitus. Adrenocorticotropic hormone adenoma-ACTH adenoma (Cushing’s disease): The patient presents with Cushing’s syndrome, with obesity and full-moon face. The diagnosis of Cushing’s disease requires differentiation from ectopic ACTH hyperplasia, adrenal tumors, and physiologic obesity. ACTH hyperplasia can cause many reactions in the patient’s body and can seriously affect the patient’s quality of life and health. The preferred treatment for ACTH adenoma is surgery, there is no clear and effective drug treatment, and gamma knife is only used as a postoperative residual complementary treatment. The main goal of surgery is to remove the tumor as completely as possible and lower the ACTH value to normal. Indicators of cure: No residual tumor on MRI review, normal range of ACTH review. The main manifestation is pituitary ACTH-dependent Cushing’s syndrome, the average duration of the disease is 3-4 years, mostly in young adults, more women than men. (1) Fat metabolism disorder and distribution abnormalities: obvious centripetal obesity, full moon face, buffalo back, supraclavicular fat pad, and relatively thin limbs. (2) Abnormal protein metabolism: catabolism is greater than anabolic metabolism, resulting in thin skin, dilated capillaries, polycythemia, and purple lines on the skin. Muscle weakness, muscle atrophy, incision not easy to heal, hetero-infection. Osteoporosis, low back throbbing pain, prone to pathological fractures. (3) Abnormal glucose metabolism: leads to abnormal glucose tolerance ( 75%) and diabetes mellitus (8-10%). (4) Disorders of water-electrolyte metabolism: hypokalemia, hypochlorhydria, hypernatremia, and in severe cases, hypokalemic alkalosis, requiring emergency treatment. Water and sodium retention can lead to hypertension, the incidence is 80%-90%. (5) gonadal function: excessive cortisol inhibits pituitary gonadotropin, 71%-87% of female patients have hypogonadism, scanty menstruation, amenorrhea, overflowing breast, infertility; about 20% of male patients have hypogonadism, impotence, sperm reduction, testicular atrophy. Secondary increase in adrenocortical male hormones can lead to acne (mostly on the face and chest and back), increased female hairs, beard growth, and enlarged throat nodes. (6) Other manifestations: Some patients have mental abnormalities, with depression being more common. Pre-pubertal onset can seriously affect growth and development. Late onset patients often die due to complications of cardiovascular and cerebrovascular diseases, respiratory diseases and infectious diseases. Surgical treatment: Once the diagnosis of Cushing’s disease is established, the ideal treatment of choice to achieve a cure without causing permanent adrenal and pituitary insufficiency is transsphenoidal microsurgical excision of pituitary ACTH adenomas, which are mostly buried in the pituitary gland. In addition to resecting the tumor, the pituitary gland should also be resected. In addition to resection of the tumor, a major excision of the peritubular pituitary tissue should be performed (in adolescent and fertile adults), or a subtotal excision (in non-fertile adults), which can improve the surgical outcome. If no lesion is found on exploration, subtotal pituitary resection should be performed rather than readily performing total pituitary resection. The overall cure rate of Cushing’s disease is reported in the literature to be between 74% and 84%. The cure remission rate of Cushing’s disease in our hospital is 88.7%, including 91.7% for ACTH adenoma, 72% for ACTH cell hyperplasia, and 80% for those without adenoma and hyperplasia. The efficacy of different resection methods varied, with the cure remission rate of 95.9% for subtotal resection of tumor plus peritumoral pituitary tissue, 86.7% for major peritumoral pituitary resection, and 80% for selective resection of tumor alone. In most patients, cortisol rapidly decreased to normal or below normal about 1 week after surgery, and the level of cortisol within 1 week after surgery was consistent with that of 3-6 months after surgery. Recovery in those with postoperative symptoms of hypocortisolism takes 3 to 12 months. The recurrence rate of pituitary ACTH adenoma after surgery ranges from 6% to 25%. For those who are not in remission or have recurrence and are still pituitary in origin, re-exploration of the pituitary gland via the pterygoid gland and total pituitary resection should be preferred. Radiotherapy, adrenalectomy or drug therapy can also be chosen according to the specific situation.