Background: Pituitary adenomas may cause problems because of hormonal hypersecretion, pituitary hormonal failure, vision loss, headaches and/or bleeding into the tumor (apoplexy). Objectives: The purpose of this study was to evaluate the efficacy of the endoscopic endonasal approach in managing pituitary adenoma concerning the resection rate and other clinical outcomes. Also, to assess the safety of the approach. Patients and methods: A prospective cohort study was conducted on twenty-four patients undergoing endonasal transsphenoidal approaches for pituitary adenomas at the Department of Neurosurgery, Zagazig University Hospitals during the period from March 2022 to October 2022. All patients were subjected to complete clinical examination, hormonal assessment, and neuroimaging. Results: This study demonstrated that among cases with hypopituitarism (66.7% became normal after treatment and 33.3% remained suffering from hypopituitarism) with statistically significant difference between pre & post treatment (p=0.03). For cases with normalized hormonal level pre-operative change to 5 cases hypopituitarism (4 transient diabetes insipidus and one case permanent Diabetes insipidus at one or more axis) and 13 cases remained normalized with statistically significant difference between them (p < 0.001). All cases of increased GH, ACTH and prolactin showed complete improvement after treatment and 90% of prolactinoma improved after treatment. Conclusion: It could be concluded that the minimally invasive endoscopic endonasal transsphenoidal approach is an effective and safe approach for the management of pituitary adenomas.