1.What other treatments are available for pituitary tumors besides surgery? To this day, pituitary tumor treatment is still mainly surgery. Some types of pituitary tumors can be treated with medication. Radiation therapy is divided into conventional radiation therapy and stereotactic radiation therapy, and conventional radiation therapy is not used much nowadays because of obvious radiation damage. Stereotactic radiation therapy is suitable for postoperative residual tumors in the cavernous sinus, those whose tumors recur and should not be operated, those who are contraindicated for surgery or unwilling to operate, and some patients with microadenoma. 2.How should pituitary growth hormone (GH) adenoma be treated? The first choice of treatment for GH adenoma is surgery, as experienced operators have a high rate of total resection and good surgical safety, which can rapidly reduce the size of the tumor, improve endocrine and systemic organ functions, and relieve the symptoms of optic nerve compression. Growth inhibitor drug therapy can also achieve similar effects as surgery, but the high price of the drug is a deterrent to most patients because it cannot eradicate the tumor and requires long-term or even lifelong use. However, short-term preoperative use of growth inhibitors can significantly improve the function of body organs and reduce the risk of surgery. It is believed that the combination of drugs and stereotactic radiation therapy has significant efficacy in treating postoperative residual tumors. 3. How are pituitary ACTH adenomas (Cushing’s disease) treated? Pituitary ACTH adenomas are very damaging to the body organs and often the tumor is small, but the symptoms are very pronounced and the patient is in great pain. Surgery is considered to be the only definitive treatment for pituitary ACTH adenomas. Because most pituitary ACTH adenomas are small when diagnosed, they can be removed by transnasal butterfly surgery. In some cases with significant symptoms and endocrine tests (including blood sampling from the subclavian sinus) that adequately support the diagnosis of pituitary ACTH adenoma, but where imaging does not yet clearly demonstrate the tumor, surgical treatment options of tumor exploration and selective pituitary adenomectomy are also available. 4. How should pituitary thyrotropin (TSH) adenoma be treated? Pituitary TSH adenomas are the least common of all pituitary adenoma subtypes. The preferred treatment is surgery, and preoperative care should be taken to control hyperthyroidism. It is important to note that some patients with primary hypothyroidism (hypothyroidism) can also develop TSH hyperplasia in the pituitary gland secondary to a pituitary TSH adenoma, which appears very similar to a pituitary tumor on MRI and is effectively treated with medication. 5. How should pituitary non-functional adenoma be treated? Pituitary non-functional adenoma is mostly seen in middle-aged and elderly patients who come to the clinic due to the loss of vision caused by tumor compression on the optic nerve. Surgery is the preferred treatment for pituitary non-functional adenoma. This type of tumor is tough, adheres closely to the normal pituitary gland, and is usually large by the time it is detected, so there is a higher chance of postoperative decline in pituitary function than any other type of pituitary adenoma. 6.Does elevated blood prolactin (PRL) necessarily mean that I have a pituitary tumor? Elevated blood PRL, also known as hyper-PRLemia, usually manifests as amenorrhea (or menstrual disorders), breast milk production and elevated blood PRL. There are many causes of elevated blood prolactin, but in general, about 90% of them are due to pituitary tumors. Other causes, such as medications or other organ diseases, can also lead to elevated blood prolactin, such as morphine, ranitidine, cimetidine, antidepressants, etc. It is also common for primary hypothyroidism to cause elevated blood PRL. There are also some unexplained (idiopathic) hyperprolactinemia that may improve on its own without treatment. Therefore, it is important to seek medical attention when elevated PRL is detected. 7. How should pituitary prolactin (PRL) adenomas be treated? Pituitary PRL adenomas are the most common pituitary adenomas, with microadenomas accounting for about 90% of them. Most pituitary PRL microadenomas can be treated with medication. The current domestic treatment for pituitary PRL adenomas is bromocriptine, which aims to lower blood PRL and reduce the size of the tumor. Because of the great risk of surgery for large invasive pituitary PRL adenomas, drug treatment is also an effective and safe method. However, the disadvantages of drug treatment are: long-term medication, drug resistance, drug side effects, easy to miscarry after stopping the drug and the unpredictability of tumor enlargement in late pregnancy, so many patients choose the increasingly safe transnasal butterfly surgery, according to statistics, the total resection rate of pituitary prolactin microadenoma surgery in our department is about 94%. 8.Why some pituitary tumors cannot be operated via transnasal butterfly surgery, but should be operated by craniotomy? More than 90% of pituitary tumors can be operated by transnasal butterfly surgery, and this surgical approach is accepted by most pituitary tumor patients because of the minimal trauma. However, pituitary tumors have diverse biological and morphological characteristics, and some pituitary tumors tend to grow into various intracranial cavities, so transsphenoidal butterfly surgery is not adequate for total removal of the tumor, or cannot quickly achieve the purpose of relieving optic nerve compression, so the surgeon will adopt a reasonable and specific craniotomy plan. 9.What are the factors that may affect the surgical result? Many factors may affect the surgical outcome and vary from person to person. Overall, the patient’s age, physical condition, comorbidities, tumor volume, texture, blood supply, and the relationship between the tumor and the surrounding neurovascular may all affect the surgical outcome. It is recommended to actively communicate with the surgeon before surgery to fully understand the risks of surgery and how to deal with them. 10.What should I pay attention to before pituitary tumor surgery? Before pituitary tumor surgery, attention should be paid to actively treating comorbidities such as hypertension and diabetes, avoiding spicy diet and taking blood-activating supplements, regulating psychological state and cultivating good work and rest habits. Patients preparing for transnasal butterfly surgery should pay more attention to the cleanliness of the mouth and nose to avoid upper respiratory tract infection. 11.What are the most common complications after pituitary tumor surgery? The most common complications after pituitary tumor surgery are water and electrolyte disorders with uncomfortable symptoms such as dysuria, poor appetite, malignancy and chest tightness. They usually occur within one week after surgery and are not difficult to treat. Patients should consume more sodium and potassium rich foods, such as salted eggs, pickles, oranges and bananas, and consume water to quench the feeling of thirst. If in doubt or if the patient’s condition is serious, he or she should consult the doctor and nurse at any time. Other common complications after transsphenoidal pituitary tumor surgery include cerebrospinal fluid leakage and nasal bleeding. Patients should try to avoid forceful movements within one month after surgery. 12.How should family members cooperate with doctors and nurses after pituitary tumor surgery? In order to shorten the recovery time after pituitary tumor surgery and minimize the occurrence of postoperative complications, it is important for family members to accompany and cooperate with the patient. As the closest person to the patient, family members are often the bridge of good communication between the patient and medical staff. After pituitary tumor surgery, abnormal changes may occur in the patient’s fluid intake, diet, psychology, vision and other neurological functions, so family members should accurately measure the patient’s water intake and urine volume, understand the patient’s various discomforts, provide timely feedback to doctors and nurses, and listen to specific suggestions from doctors during room visits. The family members should accurately measure the patient’s water intake and urine volume, understand the patient’s discomfort, give feedback to the doctor and nurse, and listen to the doctor’s specific suggestions during the room visit. 13.Why should I take hormones before and after pituitary tumor surgery? Pituitary tumor surgery will affect the function of pituitary gland, and most of them will have temporary decrease of pituitary hormone level, which will lead to decrease of immunity and stress ability of the body and bring hidden danger to patients’ post-operative recovery. In addition to the need for hormones during hospitalization, hormones should also continue to be taken for one month after discharge, and then be reduced week by week until they are discontinued. 14.How to review after pituitary tumor surgery? After pituitary tumor surgery, regular review should be conducted. The review mainly includes MRI enhancement of the saddle area and endocrine function to fully understand the extent of tumor resection and assess the function of pituitary axis, so as to facilitate the formulation of further treatment plan. Usually, the immediate post-operative review is scheduled within one week and two months after surgery, and the subsequent review time can be recommended by the attending physician at the follow-up appointment. If you still have questions, please ask your doctor before discharge or read the Discharge Instructions section in the discharge summary carefully. 15.What are the issues that need attention after pituitary tumor surgery at home? After pituitary tumor surgery, you should take rest and avoid strenuous movements. Take medication on time according to the discharge medical advice. Common discomforts include headache and dizziness, nausea, etc. After transsphenoidal surgery, patients have dry nasal cavity, decreased sense of smell, clear watery snot and blood in snot, and most of the symptoms disappear on their own with time. If there is nausea and vomiting, you should go to hospital for examination to exclude electrolyte disorder, and if you still have rhinitis symptoms after one month, it is recommended to have examination and treatment in quintuplex. Sometimes clear water without viscosity and cerebrospinal fluid leakage are not easy to distinguish from the appearance, so it is prudent to go to hospital for further examination in time. Bleeding from the nasal mucosa after transsphenoidal surgery is not uncommon and may occur within one month after surgery. If it occurs, there is no need to be alarmed, and the patient should immediately go to the nearest emergency department for gauze stuffing, which is not life-threatening. 16.Do I need to change my diet after pituitary tumor surgery? There is no need to change the diet after pituitary tumor surgery, but avoid eating spicy food. If you are weak after surgery, you can consult a Chinese medicine doctor for dietary supplements. 17.What should I do if I have anterior and posterior hypopituitarism after pituitary tumor surgery? Many factors may lead to anterior and posterior pituitary hypofunction after pituitary surgery. Huge tumor size, adhesions between tumor and pituitary gland and selective pituitary gland resection are the main factors, so it is mostly seen in middle-aged and elderly patients with non-functional pituitary tumor. Hormone replacement therapy is the best method for anterior-posterior hypopituitarism, mainly including corticosteroids, thyroxine and antidiuretic hormone. 18.Can women of childbearing age have children after pituitary tumor surgery? After treatment by experienced operators, most patients with pituitary tumors do not affect their fertility after surgery. In the few patients who have decreased anterior pituitary function after surgery, there is often a combination of decreased sexual axis function and adjustment of sexual axis function can significantly improve the fertility of women of childbearing age with pituitary tumors. The same applies to male patients with pituitary tumors who have a high demand for sexual performance.