Bilateral massive adrenal hemorrhage due to sepsis: Report of two cases

Piccioli, Anna; G, Chini; Mannelli, Massimo; Serio, Mario

doi:10.1007/bf03347786

Cited by 23 publications

(13 citation statements)

References 13 publications

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“…Therefore, it has been proposed that Waterhouse-Friderichsen syndrome is a subtype of severe sepsis and any organism that can induce disseminated intravascular coagulation can lead to adrenal haemorrhage. 8 Our three cases, occurring in two district general hospitals over a three year period, demonstrate that Waterhouse-Friderichsen syndrome may be precipitated by S pneumoniae and b haemolytic streptococcus group A infection. Adrenal haemorrhage alone cannot be taken to indicate meningococcal disease, but rather sepsis, which can potentially be caused by a range of Gram positive or Gram negative pathogens.…”

Section: Discussionmentioning

confidence: 71%

“…A case of adrenal haemorrhage in an asplenic patient with S pneumoniae infection has been described previously. 8 Friderichsen himself described Waterhouse-Friderichsen syndrome after infection with S aureus, and was able to induce adrenal haemorrhage in guinea pigs with anthrax, tetanus, and diphtheria, in addition to S pneumoniae. The association with b haemolytic streptococcus group A is much more unusual, reported in three other cases in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Waterhouse–Friderichsen syndrome as a result of non-meningococcal infection: Figure 1

Hamilton

Harris²,

Foweraker³

et al. 2004

J Clin Pathol

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Waterhouse–Friderichsen syndrome—massive adrenal haemorrhage in the setting of overwhelming clinical sepsis—is usually taken at necropsy to indicate meningococcal infection, and may be the only evidence of this pathogen. This report describes three fatal cases of the syndrome in which the causative organism proved to be a streptococcus. The organisms were detected during routine coroners’ autopsies with histology and microbiological investigations. In two cases, the syndrome followedStreptococcus pneumoniaeinfection and in a third β haemolytic streptococcus group A. Thus, adrenal haemorrhage alone cannot be taken to indicate meningococcal disease and other pathogens, particularly streptococcus, must be considered.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Waterhouse–Friderichsen syndrome as a result of non-meningococcal infection: Figure 1

Hamilton

Harris²,

Foweraker³

et al. 2004

J Clin Pathol

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“…The most common etiological agent associated with the syndrome is the bacteria N. meningitidis, 18 however it can also occur during systemic disease due to group A streptococcus, pneumococci, Haemophilus influenzae, Klebsiella oxytoca, Capnocytophaga canimorsus, Pasteurella multocida, and Ewingella americana. 11,14,30,31,[141][142][143][144][145][146][147][148] Though the bacteria associated with the syndrome are rarely found in the pathological adrenal specimens of the patients who die during this syndrome, it is felt that the bacteria must also reside in the adrenal tissue and that it is most likely not demonstrated secondary to the heavy use of antibiotics antemortem. The disorder is thought to be brought about by the stressed adrenals response to endotoxin precipitating a local DIC in a physiologically altered gland.…”

Section: Bacteriamentioning

confidence: 99%

Adrenal infections

Paolo

Nosanchuk

2006

International Journal of Infectious Diseases

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Adrenal infections are an important but under-recognized clinical entity. The adrenal gland can be infected by a myriad of pathogens including fungi, viruses, parasites, and bacteria. Infection can directly or indirectly cause tissue damage and alteration in endocrine function. Direct damage occurs via microbial replication and local production of toxic compounds, such as endotoxins. Indirect damage results from alterations in the regulation of a host's immunologic and endocrine mediators in response to damage by a microbe at a distant site. Variations in pathogen tropism, adrenal anatomy, and host immune integrity contribute to the progression of active disease and discernable adrenal dysfunction. Early recognition and intervention in the case of adrenal infection can significantly improve outcome, demonstrating the need for increased clinical suspicion in the appropriate clinical setting.

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“…Although preterminal cortisol levels do not correlate with mortality (290,548), individual patients may indeed suffer from adrenal insufficiency (43,205,354,522). A Synacthen test performed on day 3 in patients with extensive DIC and shock at the ICU of the Nijmegen University Hospital revealed adrenal insufficiency in 3 of the 23 patients (cortisol increase, Ͻ0.10 mol/liter after 250 g of Synacthen) and an insufficient response in 4 other patients (cortisol increase, Ͻ0.20 mol/liter).…”

Section: Glucocorticoid Treatmentmentioning

confidence: 99%