1) Hemorrhage

- secondary  to trauma,  thrombosis, stress, bleeding diatheses or sepsis = Waterhouse-Friderichson syndrome

2) Perinatal/neonatal hypoxia or birth trauma

3) Cyst – shows arc like marginal calcification

4) Addison’s disease – bilateral adrenal calcification seen

5) Infection

- Primary TB, histoplasmosis

6) Neoplasm

- neuroblastoma – shows ill-defined, stippled and non homogeneous calcification

- pheochromocytoma – calcification seen rarely but if present shows arc like marginal calcification

- adrenal cortical adenoma/ Ca – shows irregular punctate calcification

- adrenal choristoma (myelolipoma)

- dermoid

- metastatic melanoma

- Wolman disease – a rare AR lipoidosis, presents with hepatomegaly, splenomegaly and enlarged adrenals with punctuate cortical adrenal calcification.