Adrenal tuberculosis is one of the common diseases of primary adrenal hypofunction, usually caused by hematogenous dissemination of tuberculosis bacilli, mostly involving bilateral adrenal glands, unilateral is less common, and the course of the disease is long, several years or more. The CT manifestations of adrenal tuberculosis are different at different stages. In the early stage, the adrenal glands are enlarged, with recognizable contours, and the calcified foci have a low probability of appearing, which are pinpoints or dots, and there may be signs of inflammatory exudation as well as caseous necrosis, which leads to limited hypodense foci. Intermediate adrenal glands show marked enlargement, irregular morphology, prevalence of calcification, rough scattered distribution, and absence of limited foci of low density. In the later stage, due to the replacement of calcified and fibro-proliferative tissues, the adrenal gland often atrophies, manifesting as normal size or loss of normal morphology, and the calcified foci are plaque-like or streak-like changes. With the treatment of tuberculosis, the adrenal gland volume in some cases can gradually return to normal, which may be accompanied by calcified deposits. CT manifestation of adrenal tuberculosis is not specific, and when adrenal volume increases, it should be differentiated from adrenal hyperplasia, adrenal adenoma, adrenal lymphoma, adrenal metastasis, and so on. When adrenal atrophy calcification, it should be differentiated from specific adrenal atrophy and simple adrenal calcification.