Segmentation of grayscale medical images is challenging because of the similarity of pixel intensities and poor gradient strength between adjacent regions. The existing image segmentation approaches based on either intensity or gradient information alone often fail to produce accurate segmentation results. Previous approaches in the literature have approached the problem by embedded or sequential integration of different information types to improve the performance of the image segmentation on specific tasks. However, an effective combination or integration of such information is difficult to implement and not sufficiently generic for closely related tasks. Integration of the two information sources in a single graph structure is a potentially more effective way to solve the problem. In this paper we introduce a novel technique for grayscale medical image segmentation called pyramid graph cut, which combines intensity and gradient sources of information in a pyramid-shaped graph structure using a single source node and multiple sink nodes. The source node, which is the top of the pyramid graph, embeds intensity information into its linked edges. The sink nodes, which are the base of the pyramid graph, embed gradient information into their linked edges. The min-cut uses intensity information and gradient information, depending on which one is more useful or has a higher influence in each cutting location of each iteration. The experimental results demonstrate the effectiveness of the proposed method over intensity-based segmentation alone (i.e. Gaussian mixture model) and gradient-based segmentation alone (i.e. distance regularized level set evolution) on grayscale medical image datasets, including the public 3DIRCADb-01 dataset. The proposed method archives excellent segmentation results on the sample CT of abdominal aortic aneurysm, MRI of liver tumor and US of liver tumor, with dice scores of 90.49±5.23%, 88.86±11.77%, 90.68±2.45%, respectively.