Muscular abnormalities are uncommon manifestations of secondary adrenal insufficiency [1]. Herein, an elderly woman with an unusual muscular presentation of hypopituitarism due to empty sella and secondary adrenal insufficiency is described. A 75-year-old woman reported severe pain and contracture in both thighs associated with progressive difficulty in walking for the past three weeks. Response to analgesics and NSAI was limited. Her past medical history was unremarkable. Physical examination showed a wellappearing woman with normal vital signs. There was pronounced stiffness and pain in the aductor muscles of both thighs. Movement of lower extremities was painful. The electromyography did not show abnormal findings. Laboratory test results showed sodium 118 mEq/l, potassium 4.4 mEq/l, creatin-kinase 356 U/l (0‐167), LDH 777 U/l (240‐480), and C-reactive protein 2.0 mg/dl (0‐0.5). An endocrine evaluation was performed due to presence of severe hyponatremia: free T4 \ 0.4 ng/dl (0.93‐1.7), TSH 1.31 mIU/ml (0.27‐4.2), FSH 1.7 mIU/l (26.5‐139), LH 0.4 mIU/l (20‐65), GH \ 0.13 pg/l, and prolactin was normal. At 10 AM, serum cortisol and plasma ACTH levels were 3.5 lg/dl (5‐20) and 29.4 pg/ml (0‐52), respectively. Twenty-four-hour urinary cortisol was 6.0 lg (10‐90). A short ACTH stimulation test showed low serum cortisol response. MRI of the brain revealed an empty sella (Fig. 1). Replacement therapy was started with hydrocortisone and levothyroxine. She has remained well since. Primary empty sella, a rare neuroradiological finding in the general population, has been related to a congenital incomplete formation of the sellar diaphragm resulting in herniation of the subarachnoid space within the sella and increasing the intracranial pressure. Most common symptoms reported as presentation of primary empty sella were headache, visual disturbances, rhinorrea, and endocrine dysfunction [2]. This patient had biochemical evidence of secondary adrenal insufficiency, and endocrinological testing demonstrated secondary adrenal insufficiency and hypopituitarism related to empty sella. The clinical syndrome developed slowly, over several weeks. Patients with slow onset adrenal insufficiency (as this) usually complain of constitutional syndrome, abdominal pain, nausea, and diarrhea. Musculoskeletal abnormalities are a rare presentation of this disease.