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Pituitary apoplexy may cause meningeal irritation signs because of blood and necrotic cells passed to subarachnoid space. Meningeal irritation signs, clinically indistinguishable from infectious meningitis, are considered rare and reviewed as presenting signs in a few cases of acromegaly. We reported 2 acromegalic patients presented with signs of meningeal irritation. First case was a pituitary apoplexy of an undiagnosed growth hormone-secreting adenoma presented with the symptoms of acute meningitis. Second case was acromegaly complicated with acute viral meningitis. In both the patients, adjunctive glucocorticoid therapy provided good outcomes. Physicians should be careful about differential diagnosis of patients with meningeal irritation signs. Rapid and early diagnosis of pituitary apoplexy may depend upon recognition of this rare presentation.