Objective <p>To investigate the clinical characteristics and etiological profile of bilateral adrenal nodules in an unselected screening population.</p> Methods <p>This post-hoc analysis was derived from a cross-sectional study conducted in China in 2021 (ClinicalTrials.gov Identifier: NCT04682938). A total of 25,356 individuals who underwent routine abdominal computed tomography (CT) scans at the Health Management Center of the First Affiliated Hospital of Chongqing Medical University between November 2020 and November 2021 were enrolled. Patients with adrenal nodules detected on CT were further evaluated for nodule malignancy and hormonal function.</p> Results <p>Among the 25,356 participants who underwent abdominal CT, adrenal nodules were detected in 351 individuals, with bilateral lesions accounting for 9.1% (32/351). Participants with bilateral and unilateral nodules showed no significant differences in baseline characteristics. Of the 25 participants with bilateral nodules who completed endocrine testing, nonfunctioning adenomas (NFA) accounted for 48% (<i>n</i> = 12), functioning lesions including cortisol autonomy and primary aldosteronism (PA) accounted for 40% (<i>n</i> = 10), and infectious lesions (tuberculosis) comprised the remaining 12% (<i>n</i> = 3). Tuberculosis was significantly more prevalent in bilateral nodules than in unilateral nodules (<i>p</i> = 0.004), while the prevalence of functioning lesions was similar between the two groups (<i>p</i> = 0.464 for cortisol autonomy; <i>p</i> = 0.168 for PA).</p> Conclusion <p>Bilateral adrenal nodules account for 9.1% of all patients with adrenal nodules in the general population. Bilateral adrenal nodules share etiological similarities with unilateral nodules but exhibit a higher proportion of infectious lesions.</p>