Background: B/L Neonatal adrenal hemorrhage and B/L adrenal cystis a relatively uncommon condition (0.2–0.55%) [1, 2]. There are many risk factors. Birth asphyxia, sepsis, coagulation disorders, traumatic delivery, and perinatal injuries. Right adrenal gland is more frequently involved (70%) than left side. Only in 10% of cases bilateral adrenal glands are involved and bilateral involvement can lead to adrenal insufficiency. Case presentation: A case of bilateral neonatal adrenal hemorrhage with bilateral adrenal cyst with adrenal insufficiency. Conclusions: Adrenal hemorrhage is noticed most often after normal delivery. Symptoms are presented in rare situation. Most common being decreased activity, feeding and dyselectrolemia. Sometimes jaundice is early presentation.