Waterhouse-Friderichsen Syndrome

Waterhouse-Friderichsen syndrome—acute 1° adrenal insufficiency due to adrenal hemorrhage associated with septicemia (usually Neisseria meningitidis), DIC, endotoxic shock. (Page 324)

Classic Presentation: Adrenal hemorrhage, hypotension, DIC

Neisseria / Meningococci (Page 138)
Meningococci: Polysaccharide capsule. Maltose fermentation.  Vaccine (type B vaccine not widely available).  Transmitted via respiratory and oral secretions. causes meningococcemia with petechial hemorrhages and gangrene of toes B , meningitis, Waterhouse-Friderichsen syndrome (adrenal insufficiency, fever, DIC, shock). Rifampin, ciprofloxacin, or ceftriaxone prophylaxis in close contacts. Treatment: ceftriaxone or penicillin G. 

Primary Adrenal Insufficiency (Page 324) 
Deficiency of aldosterone and cortisol production due to loss of gland function leading to hypotension (hyponatremic volume contraction), hyperkalemia, metabolic acidosis, skin and mucosal hyperpigmentation (due to increased MSH, a byproduct of ACTH production from proopiomelanocortin [POMC]).
Acute—sudden onset (eg, due to massive hemorrhage). May present with shock in acute adrenal crisis.