Recent studies suggest that the infarction of a pituitary adenoma may be a frequent cause of an empty sella turcica. However, to date, evidence of such progression has been largely speculative. We present the case of a patient with a pituitary macroadenoma that underwent spontaneous involution resulting in an empty sella, as documented by serial magnetic resonance imaging scans. A brief review of the proposed causes of primary empty sella, with emphasis on pituitary necrosis, is provided.