More than just the confirmation of an endocrinological diagnosis, the pathological analysis of pituitary endocrine tumors may contribute to bring crucial information in prognosis as well as useful insights in therapeutic management. Taken individually, parameters such as histopathological subtyping, Ki-67-labelling or P53 immunoexpression cannot accurately predict the outcome of patients affected by such tumors. Conversely, "mixed" classification integrating invasion assessment by imaging to histopathological diagnosis may give critical prognostic information and help the clinician in identifying those aggressive tumors that will require a careful follow-up and a more vigorous postoperative treatment. Analysis of theranostic factors such as O6-methylguanine-DNA methyl-transferase or somatostatin receptor expression may guide the choice of postoperative treatment.