Adrenal Hemorrhage

Adrenal hemorrhage becomes a hormone emergency when both glands are affected. Loss of cortisol and aldosterone can reduce vascular tone, blunt the response to catecholamines, cause sodium loss and potassium retention, and impair glucose maintenance. The bedside priority is therefore not to wait for a scan: a patient with shock out of proportion to the precipitating illness may need adrenal-crisis treatment while the cause is investigated. Waterhouse–Friderichsen syndrome describes acute bilateral adrenal hemorrhage with primary adrenal insufficiency in fulminant meningococcal sepsis. Meningococcus is not required; pneumococcal or other bacterial sepsis, coagulopathy, anticoagulation, and severe physiologic stress can produce the same endocrine emergency. Suspected meningococcal disease adds immediate infection-control and public-health responsibilities.