Objective To investigate the risk factors for pituitary adenoma apoplexy.Methods A total of 50 patients with pituitary adenoma who were treated in Xiangya Hospital of Central South University from June 2020 to December 2021 were enrolled in the study， and according to imaging and surgical data， they were divided into pituitary adenoma with apoplexy group with 23 patients and pituitary adenoma without apoplexy group with 27 patients. The risk factors for apoplexy were observed and analyzed.Results The multivariate logistic regression analysis showed that history of surgical resection of pituitary adenoma and the maximum diameter of pituitary adenoma were related influencing factors. Among these patients， 1 patient experienced subclinical apoplexy due to tumor after gamma knife treatment.Conclusion History of surgical resection of pituitary adenoma and the maximum diameter of pituitary adenoma are the high-risk factors for pituitary adenoma apoplexy， and swelling after gamma knife may suggest subclinical apoplexy.