Adrenal hemorrhage/Waterhouse-Friderichsen syndrome - Erler Zimmer 3D anatomy Series MP2090

This dissection model highlighting Adrenal Hemorrhage/Waterhouse-Friderichsen Syndrome is part of the exclusive Monash 3D anatomy series, a comprehensive series of human dissections reproduced with ultra-high resolution color 3D printing.

Clinical history

A 77-year-old man presented with a 3-day history of abdominal and flank pain with fevers and chills. He was 2 weeks post duodenal ulcer repair surgery. He was hypotensive, hyperkalemic, and hyponatremic with a purpuric rash. His blood cultures developed Escherichia coli. He did not respond to treatment and died soon after admission due to septic shock.

Pathology

The combined kidney and adrenal gland were mounted to visualize the cut surfaces. There is extensive hemorrhage in the adrenal medulla and there is extravasation of blood into the perisurrenal fat. This is an example of adrenal hemorrhage in the context of severe septic shock also known as "Waterhouse-Friderichsen" syndrome.

Further information

Waterhouse-Friderichsen syndrome is characterized by adrenal hemorrhage caused by overwhelming sepsis leading to hypotensive shock, disseminated intravascular coagulation (DIC), and corticosurrenal insufficiency. It occurs most commonly in children and rarely in adults. Neisseria meningitis causes more than 80% of cases of adrenal hemorrhage. Other organisms that can cause it include Streptococcus pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, and staphylococci.
The exact cause of the bleeding is unclear. It may be due to bacterial seeding of the adrenal vessels, DIC, or endothelial dysfunction by inflammatory mediators or bacterial toxins. Adrenal hemorrhages may occur bilaterally. Hemorrhage begins in the medulla and extends outward to the cortex and may extend into the periadrenal fat. This leads to adrenal gland failure. Patients present with rapidly progressing septic shock, diffuse purpuric skin rash, and crisis of adrenal insufficiency. Treatment includes supportive therapy, intravenous antibiotics directed against cultured organisms, and steroid therapy. The mortality rate is more than 50%.

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What advantages does the Monash University anatomical dissection collection offer over plastic models or plastinated human specimens?

• Each body replica has been carefully created from selected patient X-ray data or human cadaver specimens selected by a highly trained team of anatomists at the Monash University Center for Human Anatomy Education to illustrate a range of clinically important areas of anatomy with a quality and fidelity that cannot be achieved with conventional anatomical models-this is real anatomy, not stylized anatomy.
• Each body replica has been rigorously checked by a team of highly trained anatomists at the Center for Human Anatomy Education, Monash University, to ensure the anatomical accuracy of the final product.
• The body replicas are not real human tissue and therefore not subject to any barriers of transportation, import, or use in educational facilities that do not hold an anatomy license. The Monash 3D Anatomy dissection series avoids these and other ethical issues that are raised when dealing with plastinated human remains.