Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are frequently discussed together and considered two closely related diseases. APS involves multiple organ systems, but APSrelated endocrine manifestations are rare.[1] Among them, adrenal insufficiency (AI) is the first endocrine manifestation of APS. The prompt diagnosis of AI is critical, as this disorder has high morbidity and mortality if left untreated. Here, we report a rare case of acute AI caused by APS secondary to SLE.