Waterhouse Friedrichsen Syndrome

Question 1

Waterhouse-Friedrichsen Syndrome

Answer 1

Waterhouse-Friderichsen syndrome

Waterhouse-Friderichsen syndrome describes adrenal gland failure secondary to previous adrenal haemorrhage that was caused by severe bacterial infection.

Causes
meningococcus
Haemophilus influenzae
Pseudomonas aeruginosa
Escherichia coli
Streptococcus pneumoniae

The features are those of hypoadrenalism, i.e.:
lethargy, weakness, anorexia, nausea & vomiting, weight loss
hyperpigmentation (especially palmar creases), vitiligo, loss of pubic hair in women
crisis: collapse, shock, pyrexia

Question 2

Waterhouse Friedrichsen Syndrome - Example Question

Answer 2

An 18-year-old male with no prior medical history is admitted to the resuscitation room of Emergency Department where you are asked to assess him. He is noted to be hypotensive, tachycardic and febrile. Further assessment highlights a widespread, non-blanching, purple rash. He is diagnosed with meningococcal septicaemia and is treated appropriately. Nevertheless, his condition deteriorates further when he also develops Waterhouse-Friderichsen syndrome. Which of the following sets of blood results would be most consistent with his condition at this point?

Na+ 147mmol/L, K+ 5.8mmol/L, Glucose 7.5mmol/L 
Na+ 147mmol/L, K+ 3.0mmol/L, Glucose 2.0mmol/L 
> Na+ 129mmol/L, K+ 5.8mmol/L, Glucose 2.0mmol/L 
Na+ 147mmol/L, K+ 5.8mmol/L, Glucose 11.5mmol/L 
Na+ 129mmol/L, K+ 5.8mmol/L, Glucose 11.5mmol/L 

Waterhouse-Friderichsen syndrome is defined as adrenal failure due to bleeding into the adrenal glands (otherwise referred to as haemorrhagic adrenalitis) and is most commonly caused by meningococcal septicaemia.

The biochemical pattern which results is analogous to that seen in an Addisonian crisis, and so you would expect to see hyponatraemia, hyperkalaemia and hypoglycaemia