A 6-year-old boy with fulminant meningococcemia suddenly develops shock, disseminated intravascular purpura, and collapse. Autopsy reveals massive bilateral adrenal hemorrhage with cortical necrosis. What is the underlying mechanism of the adrenal lesion?
- A Bilateral adrenal hemorrhage causing acute cortical insufficiency during overwhelming sepsis ✓
- B Autoimmune destruction of adrenocortical cells
- C Metastatic infiltration of both adrenal glands by lymphoma
- D Enzyme block in cortisol biosynthesis leading to cortical hyperplasia
Correct answer: A. Bilateral adrenal hemorrhage causing acute cortical insufficiency during overwhelming sepsis
Explanation
Waterhouse-Friderichsen syndrome is bilateral adrenal hemorrhage with acute adrenocortical insufficiency occurring in the setting of overwhelming bacterial septicemia, classically Neisseria meningitidis in children. The hemorrhagic infarction of the cortex precipitates cardiovascular collapse. Autoimmune destruction (option B) causes chronic primary adrenal insufficiency over months to years, not fulminant shock, which is the discriminating feature against the distractor.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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