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Medicine (MD/DO)
Adrenal Disorders
Waterhouse-Friderichsen Syndrome

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Waterhouse-Friderichsen Syndrome

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Waterhouse-Friderichsen Syndrome

Waterhouse-Friderichsen syndrome is usually caused by Neisseria meningitidis infection, and is defined as 1º adrenal failure due to massive adrenal hemorrhage. This syndrome is also associated with septicemia, DIC and hypotension leading to endotoxic shock.
Acute 1° Adrenal Insufficiency
(1) Wand Acute-angle in Damaged Adrenal-gland

This syndrome is defined by rapidly developing adrenocortical insufficiency caused by massive hemorrhage. Patients typically show hypoglycemia, hyponatremia, and hyperkalemia, along with adrenal failure in the ACTH stimulation test.

Adrenal Hemorrhage
Adrenal-gland with Hammer-hemorrhage

Waterhouse-Friderichsen syndrome involves massive adrenal hemorrhage, which often occurs bilaterally. This hemorrhagic adrenalitis is typically caused by tubercular infection of the adrenal glands by the bacterium Neisseria meningitidis.


As a combined result of 1º adrenal failure and massive hemorrhage, patients display hypotension, which can rapidly progress to septic shock.

Neisseria meningitidis
Knife Men-in-tights

Neisseria meningitidis is a common cause and association with Waterhouse-Friderichsen Syndrome (WFS), as it can acutely and selectively affect the adrenals. Pseudomonas, Haemophilus, and Staphylococcus aureus can also be associated with WFS.


Disseminated Intravascular Coagulation (DIC) is another common association with Waterhouse-Friderichsen Syndrome (WFS). Patients develop purpura and petechiae and can display alterations of PT and PTT, further suggesting DIC with this syndrome.


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