Adrenal hemorrhage
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| Waterhouse-Friderichsen syndrome Classification and external resources | |
| ICD-10 | A39.1, E35.1 |
|---|---|
| ICD-9 | 036.3 |
| DiseasesDB | 29316 |
| eMedicine | med/3009 |
| MeSH | D014884 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
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Waterhouse-Friderichsen syndrome (WFS) is massive, usually bilateral, hemorrhage into the adrenal glands caused by fulminant meningococcemia.[1] WFS is characterised by overwhelming bacterial infection, rapidly progressive hypotension leading to shock, disseminated intravascular coagulation (DIC) with widespread purpura, particularly of the skin, and rapidly developing adrenocortical insufficiency associated with massive bilateral adrenal hemorrhage.
Epidemiology
Meningococcus is another term for the bacterial species Neisseria meningitidis, which causes the type of meningitis which usually underlies this syndrome. Meningococcal meningitis occurs most commonly in children and young adults, and can occur in epidemics. In the United States it is the cause of about 20% of meningitis cases. At one time it was common among military recruits, but administration of the preventive meningococcal vaccine has greatly reduced this number. Freshman college students living in dormitory housing who have not been vaccinated are another risk group.
WFS can also be caused by Streptococcus pneumoniae infections, a common bacterial pathogen typically associated with meningitis in the adult and elderly population.[1] Staphylococcus aureus has recently also been implicated in pediatric WFS.[1]
Routine vaccination against meningococcus is recommended for people who have poor splenic function (who, for example, have had their spleen removed or who have sickle-cell anemia which damages the spleen), or who have certain immune disorders, such as complement deficiency.[1]
Historical
Waterhouse-Friderichsen syndrome is named after Rupert Waterhouse (1873–1958), an English physician, and Carl Friderichsen (1886–1979), a Danish pediatrician, who wrote papers on the syndrome, which had been previously described.[1][1]
Symptoms
Waterhouse-Friderichsen syndrome is the most severe form of meningococcal septicemia. The onset of the illness is nonspecific with fever, rigors, vomiting and headache. Soon a rash appears; first macular, not much different from the rose spots of typhoid, and rapidly becoming petechial and purpuric with a dusky gray color. Hypotension is the rule and rapidly leads to septic shock. The cyanosis of extremities can be impressive and the patient is very prostrated or comatose. In this form of meningococcal disease, meningitis generally does not occur. There is hypoglycemia with hyponatremia and hyperkalemia, and the Synachten test demonstrates the acute suprarenal failure. Leukocytosis need not to be extreme and in fact leukopenia may be seen and it is a very poor prognostic sign. CRP levels can be elevated or almost normal. Thrombocytopenia is sometimes extreme, with alteration in PT and PTT suggestive of DIC. Acidosis and acute renal failure can be seen as in any severe sepsis. Meningococci can be readily cultured from blood or CSF, and can sometimes be seen in smears of cutaneous lesions.
Treatment
Fulminant meningococcemia is a medical emergency and need to be treated with adequate antibiotics as fast as possible. Benzylpenicillin is the drug of choice with chloramphenicol as a good alternative in allergic patients. Hydrocortisone can sometimes reverse the hypoadrenal shock. Sometimes plastic surgery and grafting is needed to deal with tissue necrosis.
Ceftriaxone is an antibiotic commonly employed today.
References
External links
- Whonamedit.com page on the eponym
de:Waterhouse-Friderichsen-Syndrom
WikiDoc Research Resources for Adrenal hemorrhage | |
|---|---|
| Articles on Adrenal hemorrhage | Most recent articles on Adrenal hemorrhage • Most cited articles on Adrenal hemorrhage • Review articles on Adrenal hemorrhage • Articles on Adrenal hemorrhage in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Adrenal hemorrhage | Powerpoint slides on Adrenal hemorrhage • Images of Adrenal hemorrhage • Photos of Adrenal hemorrhage • Podcasts & MP3s on Adrenal hemorrhage • Videos on Adrenal hemorrhage |
| Evidence Based Medicine Regarding Adrenal hemorrhage | Cochrane Collaboration on Adrenal hemorrhage • Bandolier on Adrenal hemorrhage • TRIP on Adrenal hemorrhage |
| Cost Effectiveness of Adrenal hemorrhage | Cost Effectiveness of Adrenal hemorrhage |
| Clinical Trials Involving Adrenal hemorrhage | Ongoing Trials on Adrenal hemorrhage at Clinical Trials.gov • Trial results on Adrenal hemorrhage • Clinical Trials on Adrenal hemorrhage at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Adrenal hemorrhage | US National Guidelines Clearinghouse on Adrenal hemorrhage • NICE Guidance on Adrenal hemorrhage • NHS PRODIGY Guidance • FDA on Adrenal hemorrhage • CDC on Adrenal hemorrhage |
| Textbook Information on Adrenal hemorrhage | Books and Textbook Information on Adrenal hemorrhage |
| Pharmacology Resources on Adrenal hemorrhage | Dosing of Adrenal hemorrhage • Drug interactions with Adrenal hemorrhage • Side effects of Adrenal hemorrhage • Allergic reactions to Adrenal hemorrhage • Overdose information on Adrenal hemorrhage • Carcinogenicity information on Adrenal hemorrhage • Adrenal hemorrhage in pregnancy • Pharmacokinetics of Adrenal hemorrhage • |
| Genetics, Pharmacogenomics, and Proteinomics of Adrenal hemorrhage | Genetics of Adrenal hemorrhage • Pharmacogenomics of Adrenal hemorrhage • Proteomics of Adrenal hemorrhage |
| Newstories on Adrenal hemorrhage | Adrenal hemorrhage in the news • Be alerted to news on Adrenal hemorrhage • News trends on Adrenal hemorrhage |
| Commentary on Adrenal hemorrhage | Blogs on Adrenal hemorrhage |
| Patient Resources on Adrenal hemorrhage | Patient resources on Adrenal hemorrhage • Discussion groups on Adrenal hemorrhage • Patient Handouts on Adrenal hemorrhage • Directions to Hospitals Treating Adrenal hemorrhage • Risk calculators and risk factors for Adrenal hemorrhage |
| Healthcare Provider Resources on Adrenal hemorrhage | Symptoms of Adrenal hemorrhage • Causes & Risk Factors for Adrenal hemorrhage • Diagnostic studies for Adrenal hemorrhage • Treatment of Adrenal hemorrhage |
| Continuing Medical Education (CME) Programs on Adrenal hemorrhage | CME Programs on Adrenal hemorrhage |
| International Resources on Adrenal hemorrhage | Adrenal hemorrhage en Espanol • Adrenal hemorrhage en Francais |
| Business Resources on Adrenal hemorrhage | Adrenal hemorrhage in the Marketplace • Patents on Adrenal hemorrhage |
| Informatics Resources on Adrenal hemorrhage | List of terms related to Adrenal hemorrhage |
Acknowledgements
The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.
WikiDoc Research Resources for Adrenal hemorrhage | |
|---|---|
| Articles on Adrenal hemorrhage | Most recent articles on Adrenal hemorrhage • Most cited articles on Adrenal hemorrhage • Review articles on Adrenal hemorrhage • Articles on Adrenal hemorrhage in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Adrenal hemorrhage | Powerpoint slides on Adrenal hemorrhage • Images of Adrenal hemorrhage • Photos of Adrenal hemorrhage • Podcasts & MP3s on Adrenal hemorrhage • Videos on Adrenal hemorrhage |
| Evidence Based Medicine Regarding Adrenal hemorrhage | Cochrane Collaboration on Adrenal hemorrhage • Bandolier on Adrenal hemorrhage • TRIP on Adrenal hemorrhage |
| Cost Effectiveness of Adrenal hemorrhage | Cost Effectiveness of Adrenal hemorrhage |
| Clinical Trials Involving Adrenal hemorrhage | Ongoing Trials on Adrenal hemorrhage at Clinical Trials.gov • Trial results on Adrenal hemorrhage • Clinical Trials on Adrenal hemorrhage at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Adrenal hemorrhage | US National Guidelines Clearinghouse on Adrenal hemorrhage • NICE Guidance on Adrenal hemorrhage • NHS PRODIGY Guidance • FDA on Adrenal hemorrhage • CDC on Adrenal hemorrhage |
| Textbook Information on Adrenal hemorrhage | Books and Textbook Information on Adrenal hemorrhage |
| Pharmacology Resources on Adrenal hemorrhage | Dosing of Adrenal hemorrhage • Drug interactions with Adrenal hemorrhage • Side effects of Adrenal hemorrhage • Allergic reactions to Adrenal hemorrhage • Overdose information on Adrenal hemorrhage • Carcinogenicity information on Adrenal hemorrhage • Adrenal hemorrhage in pregnancy • Pharmacokinetics of Adrenal hemorrhage • |
| Genetics, Pharmacogenomics, and Proteinomics of Adrenal hemorrhage | Genetics of Adrenal hemorrhage • Pharmacogenomics of Adrenal hemorrhage • Proteomics of Adrenal hemorrhage |
| Newstories on Adrenal hemorrhage | Adrenal hemorrhage in the news • Be alerted to news on Adrenal hemorrhage • News trends on Adrenal hemorrhage |
| Commentary on Adrenal hemorrhage | Blogs on Adrenal hemorrhage |
| Patient Resources on Adrenal hemorrhage | Patient resources on Adrenal hemorrhage • Discussion groups on Adrenal hemorrhage • Patient Handouts on Adrenal hemorrhage • Directions to Hospitals Treating Adrenal hemorrhage • Risk calculators and risk factors for Adrenal hemorrhage |
| Healthcare Provider Resources on Adrenal hemorrhage | Symptoms of Adrenal hemorrhage • Causes & Risk Factors for Adrenal hemorrhage • Diagnostic studies for Adrenal hemorrhage • Treatment of Adrenal hemorrhage |
| Continuing Medical Education (CME) Programs on Adrenal hemorrhage | CME Programs on Adrenal hemorrhage |
| International Resources on Adrenal hemorrhage | Adrenal hemorrhage en Espanol • Adrenal hemorrhage en Francais |
| Business Resources on Adrenal hemorrhage | Adrenal hemorrhage in the Marketplace • Patents on Adrenal hemorrhage |
| Informatics Resources on Adrenal hemorrhage | List of terms related to Adrenal hemorrhage |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
