Non-functioning pituitary macroadenomas (NFPAs) are commonly associated with headaches, visual deficits and hypopituitarism. Urgent transsphenoidal surgery (TSS) should be considered for all patients presenting with visual compromise. We evaluated outcomes in 65 patients with NFPAs undergoing TSS in our unit. Patients who had undergone previous pituitary surgery or prior radiotherapy were excluded from this evaluation, as were those with classical pituitary apoplexy and predominantly cystic lesions. The majority of patients were male (n=46; 70.8%) and mean age at the time of surgery was 57 years (range 28−88). Preoperatively, information on formal visual testing was available for 64 patients; 51 (79.7%) had visual compromise. Of these 51, pre-and postoperative comparison was possible in 50 patients and all showed some degree of visual improvement following TSS. For the 13 patients with normal vision preoperatively, outcomes of postoperative visual testing were unavailable in 2; in the remaining 11, vision remained normal postoperatively. There was no deterioration in vision in any patient. Subjective visual impairment was reported by 43 patients preoperatively, with improvement in 95.3%. In 50 of 61 patients (82.0%), preoperative hypopituitarism (at least one pituitary hormone deficit) was evident; gonadotrophins 41/57 [71.9%], TSH 37/62 [59.7%] or ACTH 15/54 [27.8%]. Increasing quartile of tumour volume was associated with increased prevalence of preoperative hypopituitarism (OR=2.15, P=0.039). Postoperatively, a new hormone deficiency in any axis occurred in 12 of 54 (22.2%) of patients, with hormone recovery in any axis in 17 of 50 (34%) of patients with preoperative deficiency. The ACTH axis demonstrated the greatest propensity for recovery postoperatively; 26.7% of patients had full or partial improvement in ACTH production (TSH 24.3%, Gonadotrophins 12.2%). In conclusion, TSS was associated with a good subjective and objective visual outcome for patients. Endocrine improvement in at least one axis occurred in a third of patients with preoperative hypopituitarism.