Waterhouse-Friderichsen syndrome results in adrenal insufficiency by which pathological mechanism?

• A Autoimmune destruction of adrenal cortical cells by anti-21-hydroxylase antibodies
• B Granulomatous replacement of adrenal cortex by Mycobacterium tuberculosis
• C Bilateral adrenal cortical haemorrhagic infarction secondary to DIC in meningococcal septicaemia ✓
• D Metastatic carcinoma obliterating both adrenal glands

Explanation

Waterhouse-Friderichsen syndrome is bilateral massive adrenal haemorrhage caused by meningococcal (Neisseria meningitidis) septicaemia triggering DIC. Endotoxin-driven coagulopathy and direct vascular injury lead to haemorrhagic infarction of the adrenal glands, resulting in acute primary adrenal insufficiency (Addisonian crisis). Autoimmune adrenalitis (Addison disease) involves chronic lymphocytic destruction; tuberculous adrenalitis causes granulomas.

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

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