Pituitary adenomas are one of the most common intracranial tumors, accounting for 10-15% of intracranial tumors, and the vast majority of pituitary adenomas are benign. Pituitary adenomas are also the most common cause of pituitary strokes. The incidence of pituitary stroke is 0.6-10% in patients known to have pituitary adenomas. Pregnancy leads to elevated hormone levels in the body that can promote pituitary adenoma growth and increase the risk of pituitary adenoma stroke. The mechanism of pituitary stroke is infarction or hemorrhagic necrosis of the pituitary gland, which can lead to endocrine dysfunction and compression symptoms. Treatment options for pituitary stroke include hormone replacement therapy and surgery. There are insufficient clinical data to demonstrate the superiority of conservative or surgical treatment in pregnant patients. The UK guidelines for the management of pituitary stroke suggest that surgery should be the first choice and as early as possible in patients with severe visual loss, visual field loss, impaired consciousness or persistent worsening of symptoms. Transnasal butterfly surgery under general anesthesia has less impact on the patient’s pregnancy and is relatively safe in mid to late pregnancy. The perioperative period requires multidisciplinary cooperation between obstetrics and gynecology, ophthalmology and other departments. Anesthetic drugs and antibiotics should be used to avoid triggering contractions and adverse effects on the fetus. In the treatment of pituitary adenoma stroke in pregnancy, transnasal butterfly surgery under general anesthesia is a safe and effective way to save the patient’s vision, and multidisciplinary cooperation is very important in the treatment of patients with visual emergencies in pregnancy.