Spinal tuberculosis (TB), or Pott's disease, is a rare but serious form of extrapulmonary TB that primarily affects the thoracic spine and can result in severe neurological complications. Patients with underlying endocrine disorders, such as panhypopituitarism, are at increased risk of developing infections due to immune suppression caused by hormonal deficiencies and long-term steroid replacement therapy. We report the case of a 24-year-old Malay male patient with a known history of empty sella syndrome and panhypopituitarism on hormone replacement therapy, who presented with progressive left lower limb weakness over one week. An MRI of the spine revealed a multiloculated pre- and paravertebral collection with intraspinal extension. A spine biopsy confirmed the presence of Mycobacterium tuberculosis via TB GeneXpert testing. The patient was started on anti-TB therapy. However, due to worsening neurological function, he underwent posterior spinal fusion and decompression surgery, which resulted in improved lower limb function. Spinal TB should be considered in patients with neurological deficits and predisposing conditions, such as endocrine disorders, even in the absence of classical TB symptoms.