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Pituitary carcinoma is extremely rare and difficult to diagnose early. Here we present a case of highly suspected pituitary malignant adenoma with early chemotherapy and radiation. A 30-year-old woman was admitted for headache and impaired vision, MRI found a sellar mass. Since there was no disturbance in serum hormone levels, she was diagnosed with non-functioning pituitary adenoma before surgery. Transsphenoidal removal of tumor was attempted but only partial resection of tumor was achieved. Pathology findings suggested a diagnosis of adenocarcinoma. PET-CT scan showed the tumor had elevated max standardized uptake value. No other abnormal sites were found, which excluded metastasis to pituitary. After surgery, the patient was treated with temozolomide assisted with radiation and tumor disappeared on MRI. No recurrence was observed on 1-year follow up. In conclusion, early temozolomide with radiation therapy for highly suspected pituitary carcinoma might be beneficial.