Abstract: Objective To explore the etiology, clinical manifestation, diagnosis and treatment of a case with adrenocortical insufficiency complicated with mesenteric panniculitis(MP). Methods Clinical manifestations, laboratory examinations and radiographic characteristics of an adrenocortical insufficiency patient complicated with MP admitted to our department in 2018 were analyzed, and its related literatures were reviewed and discussed. Results The patient was a 61-year-old female suffered from abdominal pain. Abdominal magnetic resonance imaging(MRI) showed a hyperattenuated stripe between the lesser curvature of stomach and pancreas. 18 F-fluorodeoxyglucose positron emission tomography-computed tomography(18 F-FDG PET/CT) was performed to exclude the possibility of malignancy and it showed high 18 F-FDG uptake in the lesser curvature. In December 1994, the patient underwent total right adrenalectomy, subtotal left adrenalectomy and radiotherapy due to pituitary adrenocorticotropic hormone(ACTH) adenoma and bilateral adrenal hyperplasia. Postoperative pathological result was in accordance with bilateral adrenal cortical diffuse hyperplasia. Since then, she took prednisone for replacement treatment. After this admission, the dosage of prednisone was adjusted and indomethacin was added. The symptom of abdominal pain was relieved and MP was cured. Conclusion This is a case of adrenocortical insufficiency complicated with MP. Dosage of cortisol should be increased in response to stress, while the patient does not. This may contribute to the occurrence of MP.