Because of the increasing life expectancy and improving of diagnostic methods, management of pituitary adenomas in elderly patients is growing with time and, actually, the incidence rate has reached value of 7-10 %; more than 80 % of these lesions result in non-functioning pituitary adenomas. Visual field defects and hypopituitarism, both related to mass effect, remain the leading symptoms, although these masses can be completely asymptomatic (pituitary incidentalomas) or eventually disclosed upon occurrence of apoplexy (10 %). Nevertheless, because ageing is related to several endocrinological and metabolic changes, including significant modification of the hypothalamo-hypophyseal functions, clinical features of the eventual pituitary disorder may be misdiagnosed. The rates of prevalence for macroadenomas in elderly are higher as compared to the other age groups, but these tumours do not present inner increased invasiveness, probably due to the lower cell proliferation rate identified. The surgical management of pituitary adenomas in the elderly is somehow burdened by the presence of mild and/or severe systemic co-morbidities (specially cardiovascular, respiratory and neurological disorders) found in more than 50 % of patients; this aspect dramatically increases anaesthesiological risk and significantly the mortality rate between young and elderly patients. Endoscopic endonasal approach is usually safe and successful in this group of patients, and the ophthalmological and endocrinological outcomes are satisfactory as those of the younger group, also at a long follow-up.