Adrenal gland & paraganglia

Adrenal insufficiency

Waterhouse-Friderichsen syndrome

Last author update: 1 February 2005
Last staff update: 7 June 2022

Copyright: 2002-2022,, Inc.

PubMed Search: Waterhouse-Friderichsen syndrome

Nat Pernick, M.D.
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Cite this page: Pernick N. Waterhouse-Friderichsen syndrome. website. Accessed August 13th, 2022.
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

Contributed by Eric L. Vey, M.D

Fatal meningococcemia in 10 month old boy

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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