Of note, according to Meji and colleagues [132], patients who underwent trans-sphenoidal surgery for the first time showed dural invasion in 54.2% of null-cell adenomas, while this percentage decreased to 30-35% of patients in other PAs; in patients who underwent repeated pituitary surgery, the incidence of dural invasion was increased up to 90.9% for gonadotroph, 75% for PRL, and 73.3% for ACTH secreting PAs. This evidence concerns the gene PRL and gonorrhea.