The dramatic events surrounding pituitary apoplexy are discussed. These include the compression and malfunction of cranial nerves II, II, IV and IV, as well as endocrine issues, prostration and headache. The indications for surgery are described, in particular to highlight the need for stabilisation of the patient before any surgical intervention is even considered. Then the rationale and more particularly the timing of any surgery are described, along with the skill of the operating surgeon. Finally, the techniques for both microscope and endoscopic pituitary surgery are discussed in relation to the different texture and technique alteration required for an apoplectic pituitary adenoma.