Pediatric adrenal insufficiency is often thought to mainly affect patients with congenital adrenal hyperplasia (CAH) in the newborn period. However, many cases occur outside of infancy and are not related to CAH. They often present in an insidious nature with symptoms attributed to more common and often benign etiologies. Unfortunately, if not diagnosed early, adrenal insufficiency can lead to acute adrenal crisis with hemodynamic collapse. We present the case of a 15-year-old young man with a history of hypothyroidism who presented to an ED and developed hypotension and wide complex tachycardia due to hyperkalemia. After initial fluid resuscitation and treatment for his arrhythmia, he was then emergently transported to our hospital for further work up and care. Laboratory studies ultimately diagnosed him with Autoimmune Polyendocrinopathy Syndrome Type II leading to adrenal crisis.