Purpose <p>Traumatic adrenal injuries are unusual in the pediatric population. The majority resolve without intervention, but initial imaging is often unclear regarding the presence or absence of an underlying mass. This study evaluates the incidence of adrenal injury and the need for follow-up imaging among children managed at a single pediatric trauma center.</p> Methods <p>The trauma registry was queried for all patients who were diagnosed with an adrenal injury in a Level I Pediatric Trauma Center from 1994 to 2023. Patient demographics, mechanism of injury, associated injuries, and follow-up imaging were analyzed.</p> Results <p>Of 27,747 admitted trauma patients, 58 (0.2%) were diagnosed with an adrenal injury. Median age was 12 years and 67% were male. Leading injury mechanisms were: fall (26%) or motor vehicle collision (21%). 43% of patients had two or more other injuries, 34% one other injury, and 22% an isolated adrenal injury. No patients required intervention for their adrenal injury during hospitalization. Initial imaging was concerning for a possible mass in 6 patients. One underwent follow-up MRI without evidence of adrenal lesion, four had smaller adrenal abnormalities on follow-up ultrasound, and one underwent biopsy at an outside hospital after discharge, followed by adrenalectomy there for a benign hematoma.</p> Conclusion <p>Pediatric adrenal injuries are uncommon and, in this small series, rarely required intervention. Only 6 concerning adrenal masses were identified in 30 years, with no persistent masses identified on repeat imaging. A multicenter study could better define this condition, and which patients might benefit from repeat imaging.</p> Level of evidence <p>III.</p>