The PitNET Puzzle: From Zero to Linking Molecular Behavior with Neurosurgical Aspects

The pituitary gland is considered the conductor of the hormonal orchestra, and despite its small dimensions, numerous tumoral lesions can arise within it. Over the past decade, substantial changes have been made regarding the nomenclature, which are summarized in the 5th Edition of the World Health Organization Classification of Endocrine and Neuroendocrine Tumors. Furthermore, significant breakthroughs in biomolecular mechanisms have been uncovered, which have formed the basis for the new classification. The management of these lesions varies according to several factors such as tumoral dimensions, hormonal activity, symptomatology, and radiological findings. At the same time, the therapeutic goal is represented by normalization of hormonal hypersecretion if present, control of tumoral growth and/or relief of mass effect symptoms, and preservation or restoration of the pituitary function. The current narrative review aims to explore the link between biomolecular aspects, the extent of resectability, and the postoperative outcome.