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Issue: April 15, 2007
Case: Adrenal Insufficiency
Taken from
Med-Challenger EM Career
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Question:
Bilateral adrenal hemorrhage may occur due to overwhelming septicemia or severe medical stress, especially in patients on anticoagulant therapy. It will result in intractable hypotension and death without specific treatment. Adrenal hemorrhage may occur during a particularly fulminant course of meningococcemia. The latter is also known as which of the following:
- Waterhouse-Fridericksen syndrome
- Meig's syndrome
- Sheehan's syndrome
- Meyer's syndrome
Answer:
A
Remediation:
It is important to keep the possibility of adrenal insufficiency
in mind when treating patients with overwhelming sepsis, since
most of the symptoms of acute adrenal insufficiency can also be
attributed to sepsis alone.
About the Image(s):
Image 1:
Meningococcemia with Purpura Fulminans - Adult Female
This woman experienced the sudden onset of flu-like symptoms,
accompanied within hours by purpura, some with central necrosis.
This represents purpura fulminans (disseminated intravascular
coagulation), a nonspecific but classic skin finding of
meningococcemia. The outcome was fatal in this patient.
Image 2: Meningococcemia with Purpura Fulminans in an Infant
This infant with meningococcemia shows classic purpura fulminans
with irregular purpura and necrosis, especially over the digits.
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