Sonographic diagnosis of adrenal hemorrhage in patients with fulminant meningococcal septicemia

We report two patients with fulminant meningococcal septicemia, in whom massive bilateral adrenal hemorrhages were diagnosed by ultrasound. Low plasma cortisol levels were found in one patient who eventually died. The other patient survived and has remained asymptomatic for the last three years. His adrenal function is normal. We suggest that routine ultrasound examination should be performed in patients with meningococcal sepsis and shock in order to clarify the prevalence of a renal hemorrhage. Determination of plasma cortisol levels in patients with adrenal hemorrhage, would allow identification of those with adrenal insufficiency who may benefit from steroid replacement.