The Waterhouse-Friderichsen syndrome.

Abstract

SummaryFulminating purpuric meningococcal septicaemia ‐with recovery cannot be separated clinically from the Waterhouse‐Friderichsen syndrome. The name Waterhouse‐Friderichsen Syndrome should be reserved for those cases in which the autopsy shows hemorrhages in the adrenal cortex. As the causative organism is not always the meningococcus the name fulminating purpuric septicaemia is suggested instead of fulminating purpuric meningococcal septicaemia. The author discusses the works of other investigators who assert that hemorrhages in the adrenal cortex are not always present in cases of fulminating purpuric meningococcal septicaemia, and that, where they occur, they are not likely to be of any consequence for the clinical picture or the outcome of the disease. The relation between the pituitary and the adrenals is discussed a‐nd data are compiled, pointing to the possible high endogenous ACTH production leading to high or maximal function of the adrenal cortex. It is the author's opinion that the fatal outcome in fulminating purpuric septicaemia is caused by the hyperacute infection, the shock, and the exhaustion of the adrenal cortex. If patients suffering from this disease are to have any chance of recovery, an early diagnosis, vigorous therapy against the infection, and substitutional therapy with adrenal cortical extract are essential.