The pituitary gland regulates the endocrine system of the human body. If a tumor grows in the pituitary gland, a series of problems such as endocrine disorder, headache and vision loss will follow. Do we have to cut it if it is a tumor? Is taking medicine to cure tumor a bluff? According to whether the tumor has secretion function or not, pituitary tumors are roughly divided into functional and non-functional ones. For non-functional pituitary tumor, if it is a microadenoma below 25px in size, there is no symptom and the patient does not feel headache and vision loss, it can be temporarily observed and not urgently treated by surgery. If the tumor has caused headache, vision loss and visual field defects, surgery should be preferred. The main functional pituitary tumors include prolactinomas (PRL adenomas), growth hormone pituitary tumors (GH adenomas) and adrenocorticotropic hormone pituitary tumors (ACTH adenomas) (see figure below). For prolactin pituitary tumors, you can take medication to control the progression of the tumor before elective surgery, or even shrink the tumor without surgery; for growth hormone pituitary tumors and adrenocorticotropic hormone pituitary tumors, regardless of the size of the tumor, surgery is the preferred option, and the cleaner the tumor is cut at one time, the better the postoperative result will be. Many patients mistakenly believe that surgical removal of pituitary tumors means that the pituitary gland is also removed. In fact, pituitary tumor is a tumor that occurs in the anterior and posterior lobes of pituitary gland and the remnants of epithelial cells of craniopharyngeal duct, not the pituitary gland itself, so the texture, color and location of the tumor and normal pituitary tissue are completely different. If the pituitary gland is removed, it will lead to low pituitary function and bring serious impact to the patient. Of course, to achieve complete separation and removal of the tumor, in addition to careful examination and evaluation before surgery, it depends on the surgeon’s surgical technique and experience. Generally speaking, if the tumor is not particularly large, it can be removed by transnasal endoscopic surgery; if the tumor is large, hard, or the shape in the head is like an “upside down gourd”, it is difficult to be completely removed by endoscopic surgery, and it is even difficult to be completely removed by a little clamp with a small tumor picker. Craniotomy is needed. For pituitary tumors that are tightly wrapped around the internal carotid artery, whether endoscopic transnasal or traditional craniotomy, direct excision is likely to injure the internal carotid artery and cause hemorrhage, so it is best to find a surgeon with first-class surgical skills and experience to operate, otherwise, only Gamma Knife can be used to control the continued growth of the tumor and temporarily relieve some of the symptoms. However, gamma knife is only the next best thing. Gamma knife will make the tumor hard, and it is not easy to distinguish the tumor from the pituitary gland, blood vessels and other normal tissues during the surgery, which will not be effective and increase the risk.