There is no question that high-resolution imaging techniques have revolutionized the approach to diagnostic imaging. Computed tomography (CT) and magnetic resonance imaging provide exquisite images of the adrenal glands and offer the best initial imaging approach in the evaluation of patients with suspected adrenal disease. However, an assessment of anatomy is only a portion of the diagnostic effort, which begins with a biochemical evaluation to establish the presence of adrenal gland dysfunction. With a confirmed biochemical diagnosis in hand, a logical and stepwise diagnostic approach can be tailored to a particular patient. Where scintigraphy fits in the evaluation of diseases of the adrenal cortex and medulla in the context of high-resolution imaging and which radiopharmaceuticals should be deployed has changed substantially during the last 2 decades. Adrenal functional imaging has evolved from classic planar scintigraphy to single-photon emission computed tomography (SPECT) and positron emission tomography (PET) using tracers that, by targeting specific metabolic or synthetic processes within the gland, have depicted adrenal pathophysiology. New PET/CT and SPECT/CT technologies integrate anatomic and functional information and redefine the radiotracer principle in the larger context of high resolution anatomic imaging.