We may neglect the possibility of a possible combination of pituitary tuberculosis in the treatment of severe tuberculosis. However, some cases of blood-borne or meningeal tuberculosis may be combined with pituitary tuberculosis, which affects the endocrine function of the pituitary gland and manifests as hypopituitarism. We recently treated a young man with severe tuberculosis who presented with a severe face, general pallor and apathy. Anti-tuberculosis treatment was started, and the hormone dexamethasone and high doses of antibiotics were used to combat the infection. The patient’s blood pressure remained low, and long-term antihypertensive treatment and massive plasma and albumin transfusions failed to improve it. The patient’s general condition improved after half a month of treatment, but the blood pressure still could not be corrected. A thyroid function test showed hypothyroidism, and the patient’s history was taken into account for the possible coexistence of pituitary tuberculosis, and the patient’s blood pressure gradually returned to normal after supplementation with levothyroxine tablets. Therefore, in patients with severe tuberculosis, if after anti-tuberculosis treatment, correction of anemia, correction of malnutrition and shock, the patient shows symptoms such as weakness, indifference, low blood pressure, hypoglycemia and pale skin that are not consistent with the condition, it is highly suspected that the patient has pituitary tuberculosis. In this case, because of the early use of adrenocorticotropic hormone, the manifestation was less obvious. Due to the patient’s advanced condition, adrenocorticotropic hormone and thyroid hormone had been administered, and blood pituitary hormone could not be accurately measured, and cranial MRI was prepared to determine the extent of lesion damage. The severity of hypopituitarism due to pituitary tuberculosis is related to the extent of damage to the pituitary gland. Loss of more than 50% of pituitary tissue is required for symptoms of hypofunction to develop. If pituitary tuberculosis is identified and hypofunction is present, hormone replacement therapy with adrenocorticotropic hormone, thyroid hormone, and sex hormone therapy, as appropriate, and of course anti-tuberculosis therapy is more important.