Pituitary adenoma originates from the anterior pituitary gland and is one of the common benign intracranial tumors. The incidence in the population ranges from 1 in 100,000 to 7 in 100,000 and accounts for approximately 10% of intracranial tumors. Clinical manifestations: Pituitary adenoma has many clinical symptoms, which can be manifested as acromegaly or gigantism, amenorrhea and lactation or hypogonadism (impotence, hypoactive sexual desire, etc.). Classification of pituitary adenoma: 1. Functional (or secretory) and non-functional adenoma according to whether they are endocrine or not; 2. Microadenoma (diameter <1.0cm), macroadenoma (diameter >1.0cm) and giant adenoma (diameter >3cm) according to their gross morphology. (1) Prolactin cell adenoma, accounting for 40%-60% of pituitary adenomas, with clinical manifestations of amenorrhea, lactation and infertility in women and impotence and loss of libido in men, and elevated prolactin (PRL) in blood. If PRL is >100ug/L, it can be considered a pituitary tumor, and >300ug/L, it can be more definitely a PRL adenoma. Since PRL secretion is influenced by many factors, patients with 30-100ug/L plasma PRL cannot be easily diagnosed as PRL adenoma or mixed adenoma. (2) Growth hormone cell adenoma, accounting for 20%-30% of pituitary adenomas, mainly manifests clinically as acromegaly or gigantism, with elevated plasma levels of growth hormone (GH). (3) Adrenocorticotropic hormone cell adenoma, accounting for 5%-15% of pituitary adenomas, has increased secretion of adrenocorticotropic hormone (ACTH) in the blood. The clinical manifestation is cortisolism, which can cause systemic fat, protein metabolism and electrolyte disorder. Most patients have obvious centripetal obesity, full-moon face, buffalo back and purple skin pattern, while the limbs are relatively thin. (4) Multi-secretory functional cell adenoma adenoma, containing 2 or more kinds of secretory hormone cells. There are mixed clinical manifestations of multiple endocrine dysfunctions. (5) Adenoma without endocrine function cells, accounting for 20%-35% of pituitary adenoma, has no obvious clinical endocrine disorder, but may show symptoms of compression of optic nerve and intracranial pressure increase when the tumor is large. (6) Thyrotropin cell adenoma, rare, accounting for less than 1%, has elevated plasma thyrotropin (TSH) and clinical manifestations of hyperthyroidism or hypothyroidism. (7) Gonadotropin adenoma, very rare, with elevated blood levels of sex hormones and clinical sexual dysfunction. (8) Malignant pituitary adenoma, very rare, may invade adjacent brain tissue or have intracranial metastasis. Diagnosis based on: 1, chronic headache, progressive bilateral visual acuity loss, visual field defects, and primary atrophy of bilateral optic papillae. 2. Pituitary endocrine dysfunction. Abnormal endocrine examination: plasma concentrations of GH, ACTH, PRL, TSH, T3, T4, etc. may be abnormally increased. (3) Head computed tomography (CT) shows isointense or high-density tumor shadow in the saddle and/or suprasaddle, which may have calcification and tumor enhancement on enhanced scan; (4) Head magnetic resonance imaging shows low signal in the saddle and/or suprasaddle weighted image (high signal if there is hemorrhage), T (4) Head magnetic resonance imaging with intra- and/or supra-saddle-weighted images of low signal (high signal if there is bleeding), T2-weighted images of high or isosignal origin. Treatment: (a) Principles of treatment: 1. Surgery: preferred. 2.Stereotactic radiosurgery: γ-knife or X-knife treatment can be considered for those without intracranial pressure increase sign and tumor diameter <3cm. 3.Radiation therapy: those whose tumors are not completely excised or cannot tolerate surgery. 4.Drug therapy: Those with hypopituitarism can be given drug replacement therapy, and those with secretory function adenoma can use drugs that inhibit excessive secretion of pituitary hormones. 5. Prevention of infection, symptomatic treatment, and treatment of complications if there are complications. (2) Medication principles: 1. Prednisone, cortisone, thyroxine tablets, methyltestosterone, posterior pituitary hormone and other alternative treatments can be given to improve hypopituitarism without secretory functional adenoma, which are chosen according to the needs of the disease. Bromocriptine is suitable for PRL adenoma and GH adenoma, cycloheximide is suitable for ACTH adenoma and GH adenoma, and aminoglutethimide is suitable for ACTH adenoma. It is often used as an adjuvant drug after surgery or radiotherapy. 3. Correct cerebral edema and lower intracranial pressure with 20% mannitol, tachyphylaxis and dexamethasone as the main drugs, and even human albumin can be used. 4.Pay attention to electrolyte and fluid balance, and replenish blood loss intraoperatively. 5, postoperative use of antibiotics to prevent infection as appropriate, can be combined with drugs; use neurotrophic drugs to promote brain cell recovery. 6.Treat symptomatically, and select drugs to deal with complications. Common sense of prevention: Pituitary adenoma is a benign tumor, early diagnosis and treatment is effective. 1. Chronic headache with progressive vision loss, visual field loss and endocrine changes should be considered as a possible disease, and a specialist should be consulted. 2.The more serious the preoperative vision is, the less likely it is to recover after surgery, so early diagnosis and treatment is the key, and it is also a prerequisite to strive for selective total resection. 3.A sharp decrease in bilateral vision within a short period of time suggests the possibility of pituitary stroke, and once diagnosed, emergency surgery is needed to save vision. 4.Long-term follow-up is needed after surgery, and recurrence can be considered for re-operation. 5.X-knife or γ-knife can be exempted from surgery for those with indications, but it is more expensive and cannot avoid the possibility of recurrence. 6.Pituitary microadenoma (diameter <10mm) can be treated with bromocriptine. 7. Generally, radiotherapy or drug therapy is added after surgery, and the effect is satisfactory.