As one kind of infectious diseases of adrenal gland, adrenal tuberculosis can result in a life-threatening disorder which is called primary adrenal insufficiency (PAI) due to the destruction of adrenal cortex. Computed tomography (CT) and magnetic resonance imaging (MRI) play significant roles in the diagnosis of this etiology of PAI based on the CT and MRI appearances of the adrenal lesions. In this mini-review, we intend to study the CT and MRI features of adrenal tuberculosis, which could be helpful to both endocrinologist and radiologist to establish a definitive diagnosis for adrenal tuberculosis resulting in PAI. Primary adrenal insufficiency (PAI), manifesting as clinically inadequate production or action of glucocorticoids, is a life-threatening disorder when at least 90 percent of adrenal cortex has been destroyed[1,2]. As first depicted by Thomas Addison in 1855[3], the clinical manifestation of adrenal insufficiency were characterized by weakness, malaise, nausea, fatigue, anorexia and abdominal pain, together with orthostatic hypotension, constipation, weight losing, salt craving and characteristic hyperpigmentation of the skin[4-6]. The acute syndrome appears as a medical emergency since adrenal insufficiency may result in a severe hypotensive crisis and clouded sensorium[7]. But most of the symptoms are not so specific that may delay diagnosis.