Pituitary adenomas with a brief overview of other uncommon to extremely rare sellar lesions are discussed in this chapter. More than 90% of pituitary tumors are adenomas. Prolactinomas and endocrine-inactive adenomas are the common ones. Visual problems are the most common presenting symptom in adults. Endocrinological dysfunction is the most common presenting symptom in children. Rare nonadenomatous pituitary lesions are characterized by similar clinical symptoms and radiological features. Management requires complete endocrinological, ophthalmological and radiological work-up. Surgery with a TSS approach along with hormone supplements is the preferred treatment option (except in prolactinomas). Craniotomy is reserved for patients who have tumors with suprasellar or lateral extensions that are inaccessible via the TSS approach. Prolactinomas respond best to pharmacotherapy (bromocriptine or cabergoline). Once pregnancy is established, it is recommended to withdraw bromocriptine therapy although there is no reported teratogenic or abortion risk. Surgery may be advisable if vision is threatened. Radiotherapy is usually advised for residual or recurrent tumors. Pharmacotherapy is the cornerstone of management of hormonally active adenomas in addition to surgery; additional radiotherapy is widely employed. Incidental adenomas with normal endocrinology are followed conservatively without active treatment. Up to one-third recur. Patients require lifelong follow-up.