Evidence-Based Medicine (EBM) is medicine that follows evidence. It is the process by which clinicians analyze and identify the major clinical problems of patients and apply the best and most up-to-date scientific evidence to make decisions about the treatment of patients based on their own clinical experience and knowledge, with the premise of obtaining clinical evidence from patients. Patients should be fully informed and involved in the decision making process to achieve the best clinical outcome. With the development of modern medicine, people’s concern for health and disease and their demand for medical services are constantly increasing. In the last 20 years, the “detection rate” (discovery rate) of pituitary adenomas in China has been on the rise. In fact, the incidence of pituitary adenoma is reported in the literature to be around 7.5-15/100,000; the detection rate at autopsy is 1.5-84% (average 14.4%); and the detection rate (discovery rate) at random MRI examination in normal population is 10-38.5% (average 22.5%). Due to the complexity of pituitary function and adjacent structures around the pituitary gland, patients with pituitary adenoma may have alterations in pituitary endocrine function as well as clinical symptoms and signs caused by tumor compression. In addition, due to the uneven level of diagnosis and treatment of pituitary adenoma, misdiagnosis, misdiagnosis or inappropriate treatment of the disease often occurs. Therefore, it is important to introduce the connotation and concept of evidence-based medicine into the medical practice of pituitary adenoma diagnosis and treatment to improve the overall medical standard of our discipline. In the process of pituitary adenoma diagnosis and treatment, we often face a lot of confusion: (1) In the face of the increasing trend of pituitary adenoma “detection rate”, do all pituitary adenoma patients need interventional treatment? (2) misdiagnosis and mismanagement of non-pituitary adenoma diseases (e.g., pituitary hyperplasia and pituitary inflammation); (3) limitations of a single treatment approach for aggressive pituitary adenoma; (4) how to understand and deal with the residual and recurring tumors by both patients and physicians; (5) how to provide patients with optimal interventions with comprehensive resources, etc. At the same time, due to the shackle of traditional concepts on our thinking, some medical personnel and patients often have some misconceptions, such as: it is better to believe in the lesion than not; if the diagnosis of tumor is clear, treatment is always carried out at any cost; as long as surgical treatment is given, the tumor should be completely removed, and whether the tumor can be completely removed is an important indicator to evaluate the level of a surgeon, and so on. These concepts will easily lead to “over-examination” and “over-treatment”, resulting in more post-operative complications and poor overall health of patients. It is the basic idea of every neurosurgeon to adjust the thinking from the perspective of evidence-based medicine, weigh the pros and cons, and develop a correct personalized treatment plan for the patient. We should make it clear that the main treatment aim of the disease is not only to remove the tumor, but how to make the patient’s quality of life better. The three steps of evidence-based medicine and clinical practice should be followed: accurate and detailed evidence-based evidence → scientific evaluation and decision making of the evidence → personalized interventions. Patients, physicians and evidence are the three elements of evidence-based medicine. The three steps and three elements are the basis for ensuring the best treatment effect. For this reason, we should follow the following principles in the diagnosis and treatment of pituitary adenoma. 1. The principle of ensuring the best evidence. It is necessary to make a correct diagnosis by synthesizing three aspects of evidence, such as clinical manifestations, imaging and endocrinology of the patient, one cannot be missing. The diagnosis of imaging alone is sometimes unreliable, and it is necessary to understand in detail the changes of the patient’s symptoms and signs to determine whether these symptoms and signs are related to pituitary lesions. A “pituitary adenoma” found on imaging should be carefully differentiated from other saddle lesions, and if necessary, an MRI pituitary dynamic scan or PET examination should be performed to help clarify the diagnosis. Patients should undergo a full pituitary function test, and pituitary adenomas should be staged according to hormone secretion levels and, if necessary, hormone stimulation or suppression tests should be performed. It is important to note that physiological hyperplasia of the pituitary gland can occur during puberty and female pregnancy, while pathological pituitary hyperplasia can also occur when the endocrine target glands (thyroid, adrenal, gonads) are hypofunctioning. Physiological hyperplasia does not require any treatment, while pathological hyperplasia only requires treatment to target gland function, and the pituitary gland will recover its form and function naturally. The diagnosis and staging of pituitary adenomas is the basis for choosing the correct treatment plan. Evidence-based medicine can truly serve to improve the quality and efficiency of health care services only when important health care activities are based on evidence. Expert opinion is also evidence. Expert experience is especially valuable, especially the views put forward by experts who combine evidence with experience. The reliability of expert opinions is judged mainly on the basis of whether their views are based on sufficient evidence, and in the absence of research evidence, consensus reached by multiple experts is relatively more reliable than the views of individuals. For rare or complex diseases that lack research evidence, expert opinion has a more important reference value. However, one should think dialectically and not emphasize and be satisfied with experience. I believe that many neurosurgeons have the experience of failing in front of their own experience. 2. The principle of ensuring the best therapeutic effect. The ideal treatment goals for pituitary adenoma are: (1) to control tumor growth; (2) to eliminate or reduce the mass compression effect and prevent its recurrence; (3) to control hormone levels in the normal range; (4) to alleviate the manifestations of complications caused by excessive hormone secretion levels, especially cardiovascular, pulmonary and metabolic disorders. Imaging cure is defined as no sign of tumor on imaging after surgery; while endocrinological cure is based on imaging cure to normalize the preoperative overproduction of hormone levels, the latter being the ideal standard of cure. Standardized treatment is a guarantee of recovery for patients with pituitary adenoma. Surgery, medications and radiation therapy are the main treatments for pituitary adenoma, and in deciding which approach is more beneficial in obtaining control of hormone levels and relief of mass compression effects, the treatment team should weigh the risks and benefits for each patient and develop individualized interventions, paying attention to contraindications and possible serious complications of the corresponding treatment measures. Factors to consider include the severity of the disease, the compressive effect of the mass on surrounding structures, the effect of the tumor on hormone secretion levels, and potential long-term pituitary impairment, especially in young, fertile patients. For patients with incidentally detected pituitary adenomas, especially non-functioning pituitary microadenomas, follow-up observation is the best option. This is because many patients with pituitary microadenomas do not develop them throughout their lives and have no impact on their quality of life or longevity. Due to the special biological characteristics of pituitary adenoma cells, some tumor cells grow to a certain level and do not continue to grow, forming what is known clinically as “quiescent tumors”. For these patients, any intervention is suspected to be “over-treatment”, which will do more harm than good. Surgery or other interventions are required only if there are clear symptoms associated with pituitary adenoma or if the tumor continues to grow during the follow-up period. For some menopausal women with PRL adenoma, they can also be followed up and observed, because declining estrogen levels can slow down the growth of the tumor. 3. The principle of ensuring the best course. Based on the diversity and complexity of the clinical manifestations of pituitary adenoma and the uncertainty of treatment methods and means, patients with pituitary adenoma or suspected pituitary disorders should be diagnosed and treated in large medical institutions with pituitary adenoma consultation and treatment centers. Here, neurosurgeons, endocrinologists, radiologists, radiotherapists, anesthesiologists, and nurse specialists can be brought together to form a collaborative pituitary center with a comprehensive consultation system. At the same time, this medical center should be able to measure the level of endocrine hormones, and should be equipped with high-resolution CT, MR, operating microscope, neuroendoscope, C-arm, perfect microsurgical instruments and corresponding radiotherapy equipment, so that patients can receive accurate diagnosis and optimal treatment when they visit the medical center. Pituitary surgery is extremely technical, and the 2000 edition of the “Guidelines for the Treatment of Acromegaly” clearly states that the surgeon’s surgical technique is the main decisive factor in the outcome of the surgery. For experienced surgeons, the cumulative rate of major complications (death, visual impairment and meningitis) is no more than 2%; however, if the surgeon is inexperienced, the rate of surgical complications is 3-4 times higher and the surgical outcome is significantly reduced. In order to achieve the best surgical results, pituitary surgery should preferably be done in a treatment center with the appropriate expert team; pituitary adenoma centers should also establish a pituitary adenoma patient database to ensure follow-up of pituitary adenoma patients, popularize knowledge about pituitary adenoma so that patients and their families can fully understand pituitary adenoma as a disease and cooperate with doctors to make the right choice, and the center should give appropriate guidance during the whole process of patient treatment. In addition, with the progress of science and technology, some new methods and techniques should be firstly completed in these experienced medical centers, so that the diagnosis rate of pituitary adenoma can be improved, the cure rate can be increased, the complication rate and mortality rate can be reduced, and the overall quality of medical treatment and care can be improved. In conclusion, it is important to follow the principles of evidence-based medicine in the diagnosis and treatment of pituitary adenomas. A comprehensive treatment plan should be made jointly by a dedicated pituitary adenoma treatment team. The patient’s choice of treatment options should be based on an informed understanding of the various therapeutic approaches, both to keep the patient and family fully informed of the potential drawbacks of each treatment approach and to ensure that interventions correct complex metabolic disorders and reduce the incidence of complications. All medical institutions should work under the principle of standardized treatment.