Adrenal gland & paraganglia
Adrenal insufficiency
Waterhouse-Friderichsen syndrome
Author: Nat Pernick, M.D.
Last author update: 1 February 2005
Last staff update: 7 June 2022
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: Waterhouse-Friderichsen syndrome
Table of Contents
Definition / general | Clinical features | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Differential diagnosisCite this page: Pernick N. Waterhouse-Friderichsen syndrome. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalWFsyndrome.html. Accessed April 19th, 2024.
Definition / general
- Hemorrhagic necrosis of adrenal glands, usually due to bacteremia, classically Neisseria meningitides; also Pseudomonas aeruginosa, pneumococci, staphylococcus and historically Haemophilus influenzae
- Less common causes are burns, cardiac failure, hypothermia and birth trauma
Clinical features
- More common in children, particularly before age 2 years
- Usually bilateral; newborns may have unilateral hemorrhage, more commonly in right adrenal gland
- Symptoms: shock, disseminated intravascular coagulation and adrenal insufficiency; the shock may cause the hemorrhage
- Meningococcemia (Arch Pathol Lab Med 1977;101:6)
Case reports
- Newborn boy with Echovirus type 6 infection, otherwise healthy (Mod Pathol 2001;14:85)
- 47 year old woman with Capnocytophaga canimorsus septicemia (Arch Pathol Lab Med 2000;124:859)
Treatment
- Treat underlying infection with antibiotics
- Also cortisol, electrolytes
- Must detect and treat quickly
Gross description
- Glands are enlarged and hemorrhagic with extensive cortical and medullary necrosis
Gross images
Contributed by Eric L. Vey, M.D
Fatal meningococcemia in 10 month old boy
Adrenal glands in situ
Normal (top) and hemorrhagic (bottom) adrenal glands
Microscopic (histologic) description
- Hemorrhage, necrosis, fibrin deposition, neutrophilic infiltration of medulla and cortex
- Zona glomerulosa cells may be spared
Differential diagnosis
- Central adrenal vein thrombosis
