Adrenal are graded I-VI with increasing severity having higher grading.

• Grade I = Contusion
• Grade II = Adrenal laceration involving only the cortex (<2 cm)
• Grade III = Adrenal laceration extending into the medulla (>=2 cm)
• Grade IV = >50% parenchymal destruction
• Grade V:
• Total parenchymal destruction (including massive intraparenchymal hemorrhage)
• Avulsion from the blood supply

Note that one grade increase is indicated for bilateral injuries up to grade V.

Reference:

Moore EE, Malangoni MA, Cogbill TH, et al. Organ injury scaling VII: cervical vascular, peripheral vascular, adrenal, penis, testis and scrotum. J Trauma. 1996;41(3):523-524.