Precipitated by withdrawal of steroids in an adrenalectomized patient. In patients with acute bilateral hemorrhagic necrosis of adrenals. In adults usually due to bacteremia. Newborns due to perinatal trauma. Bacterial often due to meningococcemia, less commonly Staph, pneumococcus, or Haemophilus.
Shock often occurs.
Death may occur in 24 hrs. Shock in these cases is a combination of toxemia and decrease or loss of steroids. Hemorrhage starts in reticularis. ACTH levels are diagnostic. ACTH therapy corrects the deficiency.