Adrenal hemorrhage can be caused by both traumatic and non-traumatic causes. It can affect one or both adrenal glands.Trauma most commonly affects just one adrenal gland. Usually, when just one adrenal is affected, there are no clinical or biochemical signs of adrenal hormone disfunction as the other normal gland is able to compensate. Therefore, it is commonly diagnosed incidentally. Most commonly the findings of an old adrenal hemorrhage are detected and appear as coarse calcification from the hemorrhagic incident. MRI does not directly see calcification well, thus the findings of an old adrenal hemorrhage is only seen when calcification is coarse and bulky.When both adrenal glands are affected, symptoms are often severe, leading to coma and death if steroid replacement therapy is not administered almost immediately. The most common cause of bilateral adrenal hemorrhage is inferior vena cava and bilateral adrenal vein thrombosis.