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The endocrine system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
This is a rare complication of septicaemia usually due to meningococcal infection or other infective agents. It is also known as Waterhouse–Friderichsen syndrome. Patients are ill and display the symptoms of sepsis with a fever and meningococcal rash, vomiting, salt-loss, hyponatraemia, hyperkalemia, hypoglycaemia, and dehydration causing hypotension and death. Histologically the glands are haemorrhagic and show necrosis.
Unexplained Fever In Infectious Diseases: Section 2: Commonly Encountered Aerobic, Facultative Anaerobic, And Strict Anaerobic Bacteria, Spirochetes, And Parasites
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Fulminant meningococcemia (Waterhouse-Friderichsen syndrome) is a severe bacteremic infection which can kill an otherwise healthy adult within 4 to 6 h of onset of initial clinical symptoms.10 The onset is abrupt with high fever, profound prostration, and a severe hemorrhagic syndrome (petechiae, purpura) which may evolve over a few hours. Signs of meningeal irritation may appear later or are often absent. This clinical picture is associated with vasomotor collapse (acute adrenal insufficiency) which may rapidly develop into shock, myocarditis, disseminated intravascular coagulation, coma, and death. In such a catastrophic situation, intravenous chloramphenicol 4 to 8 g/day and intravenous penicillin 20 to 24 million U/day may sometimes be lifesaving.10
The adrenal glands and other abdominal endocrine disorders
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Acute adrenal insufficiency usually presents as shock in combination with fever, nausea, vomiting, abdominal pain, hypoglycaemia and electrolyte imbalance. Waterhouse- Friderichsen syndrome is a bilateral adrenal infarction associated with meningococcal sepsis and is rapidly fatal unless immediately treated. Because of intestinal symptoms and fever, the so-called Addisonian crisis is often misdiagnosed as an acute abdominal condition.
Bilateral adrenal haemorrhage after a high energetic trauma: a case report and review of current literature
Published in Acta Chirurgica Belgica, 2020
N. Jimidar, D. Ysebaert, M. Twickler, M. Spinhoven, K. Dams, P. G. Jorens
Unilateral adrenal haemorrhage may be asymptomatic. However, bilateral adrenal bleeding can cause a primary adrenal insufficiency, a potentially life threatening disorder. Compared with unilateral adrenal injury, patients with bilateral injuries are found to have higher morbidity and mortality rates [8]. Besides blunt trauma, other predisposing factors for adrenal bleeding that may cause adrenal insufficiency include thrombophilic disorders, for example, thrombophilia or antiphospholipid syndrome, and anticoagulation therapy [9]. In Waterhouse–Friderichsen syndrome, not only meningococcemia, but also any other pathogen (bacterial, viral or fungal) resulting in fulminant sepsis with a collapsed coagulation system can lead to fatal adrenal bleeding [10]. Neoplasms are also an important differential diagnosis in the setting of adrenal bleeding. Adrenal neoplasms that are most frequently involved in haemorrhage are metastases from primarily bronchogenic cancer and renal cell carcinoma. Benign masses, pheochromocytomas and adrenal cortical carcinoma are other examples of underlying neoplastic disorders [11]. A case of myelodysplastic syndrome, resulting in haemorrhagic diathesis with adrenal bleeding has been described [12]. Excessive stressful situations including critical illness, high levels of exogenous cortisol or ACTH, pregnancy, surgery and burns have been reported as other non-traumatic aetiologies [13], whereas some cases remain idiopathic [14,15].
Endogenous Meningococcal Endophthalmitis with Isolated Joint Involvement in Immunocompetent Adults
Published in Ocular Immunology and Inflammation, 2018
Vishal Shah, Anurag Garg, Miles Stanford
Meningococcemia is the term used to describe meningococcal septicemia and is a feature of meningococcal disease in 40% of cases. Meningitis features in approximately 50%.2 Hallmarks of fulminant disease include hypotension, disseminated intravascular coagulation (DIC), multiple organ failure, osteonecrosis secondary to DIC, and adrenal hemorrhage in Waterhouse–Friderichsen syndrome.3 The most susceptible groups of the population include newborns, children in their first year, adolescents, elderly, and the immunosuppressed.4