Top Tweets for #Addisonsdisease

In 1955, the Archives of Surgery published a paper titled Management of Adreno-cortical Insufficiency During Surgery, describing the successful operation on a 37 year old Addisonian patient undergoing major spinal surgery. The paper was there in the open, respectably cited and available to anyone inclined to look. The patient's identity, naturally and properly, was withheld. And so the case remained in the annals: visible in every respect, yet detached from the identity that would have revealed its wider significance. Addison's disease begins when the two small adrenal glands that sit above the kidneys fail. They stop producing cortisol, a hormone involved in maintaining blood pressure, blood sugar, energy metabolism, and the body’s response to stress. The simplest tasks (climbing a flight of stairs, rising from a chair) may require an effort out of proportion to their apparent demands. There’s also the matter of stress. Healthy people meet illness, surgery, grief, fear, mental crisis, or injury with an invisible hormonal surge. It’s a physiological reserve they never have to think about. The body prepares itself for adversity. The Addisonian cannot. It’s one of those conditions that reveals how much of what we call character is in fact hormonal physiology. The patient in the paper was John F Kennedy. Five years after the paper was published, he won the US presidential election by a razor thin margin. If voters had learned that the handsome young senator was dependent on corticosteroids, and afflicted by chronic illness, and perhaps engaged in a daily struggle with pain and endocrine failure, Richard Nixon might well have become President instead. So Nixon enters the White House. The Camelot legend never takes hold in America. The Bay of Pigs belongs to another presidency altogether. And the Cuban Missile Crisis, perhaps the nearest our species has come to a collective obituary, is entrusted to another temperament entirely. The Cold War’s most celebrated exhibition of presidential nerve is never performed by a man whose body (undisclosed to the public) required relentless chemical maintenance just to get through the day. For Kennedy, Addison’s was an invisible dependency. He was sustained day to day on a pharmacological scaffolding. It’s quite absurd that the destiny of nations and the continued existence of several hundred million people may have rested, for a time, on the daily successful replacement of a hormone measured in milligrams.