This chapter discusses endoscopic surgery of the sella and suprasellar region, where last two decades have focused on development of instrumentation designed specifically for endoscopic pituitary surgery and on the adaptability of endoscopic transsphenoidal surgery for the treatment of a broad spectrum of skull base lesions. Clinical presentation can be as benign as headaches but other symptoms are usually dependent on the location of the pathology. Computed tomography images provide important information about the bony anatomy of the skull base, paranasal sinuses and sphenoid sinus pneumatisation. Fundoscopy must be undertaken to evaluate the presence of optic nerve atrophy. The classic bitemporal hemianopsia is found in chiasmatic compression. Iatrogenic elevation occurs by antagonizing dopamine action with such medications such as antiemetics, antidepressants, antipsychotics, and narcotics. Systemic hypertension is among the most common manifestations of Cushing’s disease. Definitive management with surgery remains the first-line therapy.