The Waterhouse‐Friderichsen Syndrome

Abstract

Summary Fulminating purpuric meningococcal septicaemia ‐with recovery cannot be separated clinically from the Waterhouse‐Friderichsen syndrome. The name Waterhouse‐Friderichsen Syndrome should be reserved for those cases in which the autopsy shows hemorrhages in the adrenal cortex. As the causative organism is not always the meningococcus the name fulminating purpuric septicaemia is suggested instead of fulminating purpuric meningococcal septicaemia. The author discusses the works of other investigators who assert that hemorrhages in the adrenal cortex are not always present in cases of fulminating purpuric meningococcal septicaemia, and that, where they occur, they are not likely to be of any consequence for the clinical picture or the outcome of the disease. The relation between the pituitary and the adrenals is discussed a‐nd data are compiled, pointing to the possible high endogenous ACTH production leading to high or maximal function of the adrenal cortex. It is the author's opinion that the fatal outcome in fulminating purpuric septicaemia is caused by the hyperacute infection, the shock, and the exhaustion of the adrenal cortex. If patients suffering from this disease are to have any chance of recovery, an early diagnosis, vigorous therapy against the infection, and substitutional therapy with adrenal cortical extract are essential.

Disseminated intravascular coagulation and the Waterhouse-Friderichsen syndrome

“…For many years it was thought that they were due to the adrenal haemorrhages with subsequent adrenal failure (Maclagan and Cooke, 1916;Friderichsen, 1918;Banks and McCartney, 1943;Cosgriff, 1944;Nelson and Goldstein, 1951). However it has been suggested that too much emphasis has been placed on the role of the adrenals in this syndrome (Aegerter, 1936;Williams, 1942;Bjorklund, 1953). In the present series there was no correlation between the extent of adrenal haemorrhages and the clinical state, and there was no response to treatment with steroids.…”

Endocrine and Metabolic Manifestations of Snakebite Envenoming

“…51 Like the pituitary, the adrenal gland is a highly vascular organ, and the etiology of hemorrhage and necrosis is likened to that of Waterhouse-Friderichsen syndrome associated with severe bacterial sepsis with Neisseria meningitidis and Streptococcus pneumoniae infections. 53 Snake venom has active constituents with both procoagulant and hemorrhagic effects that predispose to the development of DIC and, in turn, adrenal hemorrhage or necrosis. 54,55 Bilateral adrenal hemorrhage may occur because of circulatory shock due to other causes such as bleeding or CLS in the setting of RVE.…”