A patient develops Waterhouse-Friderichsen syndrome. Bilateral adrenal hemorrhagic necrosis is present at autopsy. The mechanism of adrenal destruction in this condition is BEST explained by:

• A Direct invasion of adrenal parenchyma by Neisseria meningitidis bacteria
• B Endotoxin-induced disseminated intravascular coagulation causing microvascular thrombosis and hemorrhagic infarction of the adrenal glands ✓
• C Autoimmune adrenalitis triggered by meningococcal molecular mimicry
• D High cortisol demand overwhelming adrenal reserve causing ischemic necrosis from stress response

Explanation

Waterhouse-Friderichsen syndrome (bilateral adrenal hemorrhagic necrosis) occurs classically in meningococcemia. Meningococcal endotoxin (LPS) triggers massive DIC, with widespread microvascular thrombosis throughout the adrenal gland's richly vascularized sinusoidal network. Ischemic necrosis followed by hemorrhagic transformation destroys both adrenals, causing acute primary adrenal insufficiency and adrenal crisis in the setting of overwhelming sepsis. Other gram-negative organisms (Pseudomonas, E. coli) can also cause this syndrome.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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