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Adrenal cortical carcinoma
Primary adrenal insufficiency
Congenital adrenal hyperplasia
Multiple endocrine neoplasia
Opsoclonus myoclonus syndrome (NORD)
Pancreatic neuroendocrine neoplasms
Androgen insensitivity syndrome
Polycystic ovary syndrome
Premature ovarian failure
Constitutional growth delay
Growth hormone deficiency
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Autoimmune polyglandular syndrome type 1 (NORD)
Thyroglossal duct cyst
Thyroid eye disease (NORD)
Toxic multinodular goiter
Euthyroid sick syndrome
Subacute granulomatous thyroiditis
Adrenal insufficiency: Pathology review
Adrenal masses: Pathology review
Cushing syndrome and Cushing disease: Pathology review
Diabetes insipidus and SIADH: Pathology review
Diabetes mellitus: Pathology review
Hyperthyroidism: Pathology review
Hypopituitarism: Pathology review
Hypothyroidism: Pathology review
Multiple endocrine neoplasia: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
Parathyroid disorders and calcium imbalance: Pathology review
Pituitary tumors: Pathology review
Thyroid nodules and thyroid cancer: Pathology review
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Waterhouse-Friderichsen syndrome p. 353
Waterhouse-Friderichsen syndrome p. 353, 724
Waterhouse-Friderichsen syndrome p. 140
Waterhouse-Friderichsen syndrome p. 724
Waterhouse-Friderichsen syndrome and p. 353
meningococci p. 140
presentation p. 724
Waterhouse-Friderichsen syndrome occurs when the blood vessels in the adrenal gland rupture during a severe bacterial infection, turning the adrenal glands into sacks of blood.
This results in adrenal crisis, or acute adrenal insufficiency, which is when the adrenal gland suddenly stops producing hormones.
The syndrome is named after two physicians - Waterhouse and Friderichsen who separately described the syndrome back in the early 1900’s.
Now, there are two adrenal glands, one above each kidney, and each one has an inner layer called the medulla and an outer layer called the cortex.
The adrenal cortex is subdivided into three more layers, the zona glomerulosa, zona fasciculata, and the zona reticularis.
The adrenal cortex secretes hormones under the control of adrenocorticotropic hormone, released by pituitary gland.
The outermost layer is the zona glomerulosa, which makes the hormone aldosterone.
Aldosterone acts on the nephrons of the kidney, and decrease potassium levels, increase sodium levels, and increase blood volume and blood pressure.
The middle layer is the zona fasciculata, which makes the hormone cortisol, as well as other glucocorticoids.
The main job of glucocorticoid is to increase blood glucose levels, especially when there’s emotional and physical stress.
Finally, the innermost layer is the zona reticularis, which makes a group of sex hormones called androgens.
In men, androgen stimulates development of male reproductive tissues and secondary sex characteristics like facial hair and a large Adam’s apple.
In women, androgen causes a growth spurt, and growth of underarm and pubic hair during puberty.
Waterhouse-Friderichsen syndrome is a rare and potentially life-threatening condition that occurs when the adrenal glands fail and produce insufficient amounts of cortisol and other hormones. This condition is usually caused by an overwhelming bacterial infection, most commonly meningococcal septicemia, but it can also be caused by other bacterial infections.
The characteristic symptom of the syndrome is a petechial rash throughout the body, which can turn into large purpura over time. Another potential complication of this syndrome is an Addisonian crisis, which can cause sudden lower back, abdominal or leg pain, vomiting, diarrhea, and low blood pressure leading to loss of consciousness. Other symptoms include fever and chills, which can be a sign of sepsis.
Waterhouse-Friderichsen syndrome is a medical emergency and requires immediate treatment with antibiotics to treat the underlying bacterial infection, as well as glucocorticoids to help support the person's blood pressure and metabolic needs. Other supportive care measures may also be necessary, such as IV fluids, oxygen therapy, and monitoring of vital signs.
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