Adrenals, Waterhouse Friderichsen syndrome, gross
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The adrenals in Waterhouse Friderichsen syndrome are hemorrhagic due to microthrombi, which cause infarction. The adrenal insufficiency that results creates hypotension that is unresponsive to fluid resuscitation. Corticosteroids must be given. It is usually seen in meningococcemia (Neisseria meningitidus), but can occur with other Gram-negative infections, or in DIC from any cause.