Purpose <p>Most adrenal lesions are less than 2 cm and can easily be ignored during primary review of computed tomography (CT)-scans with another question. Furthermore, adrenal lesions, including adrenal hematomas, can easily be missed in patients with multitrauma. We aimed to determine the incidence of adrenal lesions in patients with multitrauma.</p> Methods <p>This retrospective, single-center cohort analysis included 1373 patients with multitrauma (71.2% males) with a mean age of 42 (95%CI 41–43) years. One radiologist re-examined all multitrauma CT performed 2013–2017 using thin sliced imaging in at least two depictions. A second radiologist re-examined patients where an abnormality was found. Adrenal abnormalities were labelled adrenal lesions (size ≥10 mm) or hematomas, respectively. Clinical data were collected.</p> Results <p>The adrenal lesion prevalence was 2.7% (37/1373, 78% males, 22% bilateral). Of these 27% (10/37) were mentioned in the radiological report, and in those with a size ≥15 mm (n = 13), 38% (5/13) were mentioned. Of the unilateral adrenal lesions 86% (25/29) were left-sided. In the adrenal lesion group during the mean follow-up time of 75 (61–90) months none had surgery, 6% had hormones measured (all normal), and 7% had repeated adrenal imaging. The adrenal hematoma prevalence was 5.0% (68/1373, 10% bilateral). No patient had both an adrenal hematoma and an adrenal lesion. Of the unilateral hematomas 42% (26/62) were not mentioned. Of the hematomas 77% were right-sided. No patient with adrenal abnormalities had signs of adrenal insufficiency. 30-day survival rates in the adrenal lesion and hematomas groups were similar, but the hematoma group had higher injury severity score, but no longer length of hospital stay.</p> Conclusions <p>The prevalence of adrenal tumors was 2.7% and adrenal hematomas 5.0%. Most lesions were not mentioned in the image report. Few had hormonal evaluation or adrenal imaging follow-up. Survival rates were similar between the two groups.</p>