Antiphospholipid syndrome (APS) is an autoimmune disease characterized by one or both of the following: vascular thrombosis that may be arterial, venous, or both; and pregnancy morbidity.Primary adrenal insufficiency (Addison disease) results from destruction of the adrenal cortex. Symptoms and signs of adrenal insufficiency appear when more than 90% of the cortex is destroyed.Several reports have pointed out the relationship of primary adrenal failure and the presence of elevated antiphospholipid antibody (aPL) levels.In this study, MRI was performed for the 20 patients, suffering from antiphospholipid syndrome fulfilling the revised Sapporo classification criteria (Miyakis et al.,2006), the main findings were compatible with infarction in 4 (20%) and hemorrhage in 3 (15%). Adrenal gland enlargement was found in 7 (35%), bilateral involvement in 1 (5%) and the gland appearance was normal in 13 (65%).