Adrenal gland & paraganglia

Adrenal insufficiency

Waterhouse-Friderichsen syndrome

Topic Completed: 1 February 2005

Minor changes: 6 November 2020

Copyright: 2002-2021,, Inc.

PubMed Search: Waterhouse-Friderichsen syndrome

Nat Pernick, M.D.
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Cite this page: Pernick N. Waterhouse-Friderichsen syndrome. website. Accessed December 3rd, 2021.
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
  • 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

Fatal meningococcemia in 10 month old boy, contributed by Dr. Eric L. Vey, Erie County Coroner Officer, Erie, PA (USA)

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
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