British doctors could diagnose a 58-year-old woman with Addison's disease -- a rare endocrine disorder -- based on the symptoms she had during high-drama soccer games, according to a new case study.
The devout Manchester United fan, whose name was not released, developed shortness of breath, heart palpitations and "a sense of impending doom" while watching her team face premier league rivals Manchester City and Chelsea earlier this year.
"We believe that our patient was having difficulty mounting an appropriate physiological cortisol response during the big games, and therefore we present this as the first description of Manchester United induced addisonian crisis," Dr. Akbar Choudhry of Manchester's Trafford General Hospital and colleagues wrote in the Christmas issue of BMJ.
Cortisol is a hormone secreted during times of stress by the adrenal glands, which sit like toupees atop both kidneys. The hormone raises blood sugar and blood pressure to compensate for the effects of stress. But people with Addison's disease produce too little cortisol.
"Addison's is an autoimmune disease in which the body sees the adrenal gland as being foreign," said Dr. Stuart Weiss, an endocrinologist at NYU Langone Medical Center. The misguided immune response "chews up" the adrenal glands, gradually shrinking the amount of cortisol they produce.
Once diagnosed, Addison's can be treated with a 20-milligram daily dose of hydrocortisone -- a synthetic version of cortisol. But in high-stress situations, patients need higher doses.
"If people get sick, which is a natural stress, we double the baseline dose," said Weiss. "And there is no opportunity for a missed dose. A missed dose, or any kind of stressful accident, could be catastrophic."
The treatment for such a catastrophe, also known as an Addisonian crisis, is a onetime 100-milligram hydrocortisone injection, Weiss said. Patients are instructed to wear medical alert bracelets to warn others about their condition.
Addison's affects between one and three people per 100,000 in the U.S., according to National Adrenal Diseases Foundation executive director Melanie Wong, who was diagnosed with the disease at age 29.
"I was one of the lucky ones," said Wong, who is now 52. "It only took two weeks for them to diagnose me."
The disease is difficult to diagnose because many of the symptoms, such as fatigue, weakness, weight loss and mood changes, are common to other conditions.
John F. Kennedy was diagnosed with Addison's disease at age 30 -- 13 years before becoming the youngest U.S. president in 1960. He managed to conceal the diagnosis until after the election despite collapsing at the Bunker Hill parade through Charlestown, Mass., in 1946 and and a congressional visit to Britain in 1947.
"Despite his many medical conditions as well as his recurrent back problems, John F. Kennedy managed to convey an image of health and vigor that masked the true state of his health to the U.S. public," wrote Dr. Lee Mandel, a Navy Medical Corps endocrinologist in Chesapeake, Va., in a 2009 review of Kennedy's medical records.
Soccer-Induced Symptoms Reveal Rare Disease
Thanks to her new twice-daily hydrocortisone treatment regimen, the soccer fan was able to kick off the 2011-2012 season with perfect attendance at Old Trafford -- Manchester United's home turf.
Luckily, "all games were won by a large margin," Choudhry and colleagues wrote, noting the aggregate score for August and September of 14-3 in favor of the home team. When the team's form dipped in October with the worst at-home loss in 56 years, the patient happened to be on vacation, they reported.
The cheeky case study sheds light on a rare and difficult to diagnose disease that amplifies the dangers of too much stress.
"We usually tell patient the emotional stress isn't as big a problem as the physiological stress," said Dr. Lee Parks, an endocrinologist at Vanderbilt University Medical Center. "But apparently she's a big enough fan."