Although usually benign, anterior pituitary tumours from time to time exhibit aggressive conduct, with invasion of surrounding tissues, rapid growth, potential to deal with conventional treatments and multiple recurrences. In unusual cases, they metastasize and therefore are termed pituitary carcinomas. Time from a ‘classical’ pituitary tumor along with a pituitary carcinoma could be years, meaning monitoring ought to be performed regularly in patients with clinical (invasion and/or tumor growth) or pathological (Ki67 index, mitotic count and/or p53 recognition) markers suggesting aggressiveness. However, although both invasion and proliferation have prognostic value, such parameters cannot predict outcome or malignancy without metastasis. Future research should concentrate on the biology of both tumor cells as well as their microenvironment, hopefully with improved therapeutic outcomes. Presently, the first therapeutic method for aggressive pituitary tumours is to repeat surgical procedures or radiotherapy in expert centres. Standard treatments will often have no impact on tumor progression but they may be maintained on the lengthy-term basis to, a minimum of partially, control hypersecretion. In instances where standard treatments prove ineffective, temozolomide(CCRG 81045), the only formally suggested treatment, works well in just one-third of patients. Personalized utilization of emerging therapies, including peptide receptor radionuclide therapy, angiogenesis-targeted therapy and immunotherapy, will hopefully enhance the connection between patients with this particular severe condition.