Waterhouse-Friderichsen syndrome
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Waterhouse-Friderichsen syndrome
Pathology
Adrenal gland disorders
Congenital adrenal hyperplasia
Primary adrenal insufficiency
Waterhouse-Friderichsen syndrome
Hyperaldosteronism
Adrenal cortical carcinoma
Cushing syndrome
Conn syndrome
Thyroid gland disorders
Thyroglossal duct cyst
Hyperthyroidism
Graves disease
Thyroid eye disease (NORD)
Toxic multinodular goiter
Thyroid storm
Hypothyroidism
Euthyroid sick syndrome
Hashimoto thyroiditis
Subacute granulomatous thyroiditis
Riedel thyroiditis
Postpartum thyroiditis
Thyroid cancer
Parathyroid gland disorders
Hyperparathyroidism
Hypoparathyroidism
Hypercalcemia
Hypocalcemia
Pancreatic disorders
Diabetes mellitus
Diabetic retinopathy
Diabetic nephropathy
Pituitary gland disorders
Hyperpituitarism
Pituitary adenoma
Hyperprolactinemia
Prolactinoma
Gigantism
Acromegaly
Hypopituitarism
Growth hormone deficiency
Pituitary apoplexy
Sheehan syndrome
Hypoprolactinemia
Constitutional growth delay
Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Gonadal dysfunction
Precocious puberty
Delayed puberty
Premature ovarian failure
Polycystic ovary syndrome
Androgen insensitivity syndrome
Kallmann syndrome
5-alpha-reductase deficiency
Polyglandular syndromes
Autoimmune polyglandular syndrome type 1 (NORD)
Endocrine tumors
Multiple endocrine neoplasia
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Carcinoid syndrome
Pheochromocytoma
Neuroblastoma
Opsoclonus myoclonus syndrome (NORD)
Endocrine system pathology review
Adrenal insufficiency: Pathology review
Adrenal masses: Pathology review
Hyperthyroidism: Pathology review
Hypothyroidism: Pathology review
Thyroid nodules and thyroid cancer: Pathology review
Parathyroid disorders and calcium imbalance: Pathology review
Diabetes mellitus: Pathology review
Cushing syndrome and Cushing disease: Pathology review
Pituitary tumors: Pathology review
Hypopituitarism: Pathology review
Diabetes insipidus and SIADH: Pathology review
Multiple endocrine neoplasia: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
Assessments
Waterhouse-Friderichsen syndrome
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Waterhouse-Friderichsen syndrome
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USMLE® Step 1 style questions USMLE
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Which of the following organisms is most likely implicated in this patient’s presentation?
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Adrenal hemorrhage p. 716
Waterhouse-Friderichsen syndrome p. 355
Disseminated intravascular coagulation (DIC) p. 435
Waterhouse-Friderichsen syndrome p. 355, 716
Fever
Waterhouse-Friderichsen syndrome p. 140
Hypotension
Waterhouse-Friderichsen syndrome p. 716
Neisseria meningitidis
Waterhouse-Friderichsen syndrome p. 355
Septicemia
Waterhouse-Friderichsen syndrome p. 355
Shock p. 319
Waterhouse-Friderichsen syndrome and p. 355
Waterhouse-Friderichsen syndrome p. 355
meningococci p. 140
presentation p. 716
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Transcript
Content Reviewers
Rishi Desai, MD, MPHContributors
Brittany Norton, MFA
Jahnavi Narayanan, MBBS
Tanner Marshall, MS
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.
Summary
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.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "<i>Staphylococcus aureus</i>Sepsis and the Waterhouse–Friderichsen Syndrome in Children" New England Journal of Medicine (2005)
- "Waterhouse-Friderichsen syndrome without purpura due to Haemophilus influenzae group B." Postgraduate Medical Journal (1985)
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