Adrenal crisis is a group of clinical manifestation predominantly with hypotensive shock, electrolyte imbalance in a patient with adrenal insufficiency or in a patient who was abruptly withdrawn from glucocorticoid treatment acute myeloid leukaemia (AML) is one of the most common acute leukaemia in adults. Though the above diseases are commonly seen in individual patients, the coexistence of both conditions in the same patient is rare. We reported a 64-year-old African-American man with a history of bilateral deep vein thrombosis, who presented initially with fatigue, neutropenia and macrocytic anaemia. The patient developed a small bowel obstruction during his first hospital course, which resolved spontaneously with conservative management after an exploratory laparotomy. While waiting for his bone marrow biopsy, the patient developed hypotension, hyponatraemia and hyperkalaemia for which adrenal crisis was suspected. Later on, laboratory studies confirmed the diagnosis of primary adrenal insufficiency and the bone marrow was conclusive for AML.