Currently, the preferred treatment for Cushing’s disease (pituitary ACTH adenoma) is surgery, regardless of the American and European guidelines, or the domestic expert consensus. For most of Cushing’s disease, transnasal pterygoid sinus approach surgery is an option because of the small size of the tumor (less than 1 cm). Depending on the surgeon’s custom and surgical equipment, microscopic or endoscopic surgery can be chosen. In this article, according to the protocol of neurosurgery in Peking Union Medical College Hospital, we introduce the possible postoperative situations and responses based on the questions frequently asked by outpatients, hoping to help the patients with Cushing’s disease and reduce some confusion and anxiety after surgery. On the day after surgery, patients with Cushing’s disease are hypercortisolemic, i.e., the blood cortisol is higher than the normal level and the circadian secretion rhythm is lost. Patients are not given glucocorticoids preoperatively, intraoperatively, or on the postoperative day. If the tumor is clear at the time of intraoperative exploration and the tumor is satisfactorily removed, blood cortisol will drop rapidly, usually to a minimum in about 36 hours. According to bulk medical record follow-up, cortisol drops to normal or even below normal in the early postoperative period for better long-term healing. However, as cortisol drops, patients can feel very uncomfortable. These symptoms include: headache, fatigue, panic, lethargy, nausea, vomiting, polyuria, etc. The first day after surgery Generally, hormone supplementation is also not done on the first day because a 24-hour urine sample is kept for efficacy assessment. Hydrocortisone is given unless the patient presents with significant hypoadrenocorticism, such as decreased blood pressure and increased heart rate. Patients will have more pronounced symptoms of pituitary hypofunction (headache, fatigue, panic, lethargy, nausea, vomiting, polyuria, etc.). Note: The above symptoms of hypopituitarism may last for about six months to a year, and the length of time varies with each patient’s constitution. In addition to the above symptoms, some patients have hair loss, joint pain, lower limb edema, skin flaking, etc. The second day after surgery If the blood cortisol tested on the first day after surgery is less than 5, glucocorticoid supplementation is given. Patients will feel better than on the first postoperative day. Day 3 after surgery If the condition is balanced, the patient can usually be discharged. Patients are advised to stay near the hospital for about 3 more days to rule out some late onset conditions. After discharge to one week postoperatively Six days postoperatively, an electrolyte check is recommended to rule out hyponatremia, mostly due to SIADH (syndrome of inappropriate secretion of antidiuretic hormone). If hyponatremia is evident, intravenous fluids are given to limit water intake and supplement with concentrated sodium chloride and hydrocortisone. It is difficult to replace sodium alone. If the patient usually has a light diet and consumes less salt, it is recommended to increase salt intake appropriately in the week after surgery. Long-term follow-up after surgery The frequency of follow-up thereafter is 1 week, 3 months, 6 months and 1 year after surgery. If there is no sign of tumor recurrence at 1 year, the follow-up can be done once a year. The main tests are MRI with pituitary gland enhancement and pituitary hormones, including 24-hour urinary free cortisol.