All the President's Secrets: John F. Kennedy and Addison's disease

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All the President's Secrets: John F. Kennedy and Addison's disease
By: Adam J. Brown, MD & Lee R. Mandel, MD MPH (07-12-19)
Re: https://www.healio.com/news/rheumato...waAoN6EALw_wcB

It is no secret that America, like so many other countries and cultures, has long been obsessed with vitality and youth.

It is easy to think that this obsession bled its way into presidential politics only recently, with the advent of social media, where teen- and twenty-something influencers are making millions based largely on the way they look. Videos of President Barack Obama playing basketball distributed through Facebook and YouTube no doubt contributed to his image as a healthy young man, a persona that helped win him the White House in 2008.

However, casual and serious historians alike understand that this trend stretches at least as far back as 1960, when President John F. Kennedy’s suntanned and vigorous image was part of the equation that ushered him to his own Electoral College victory. This, along with the fact that, at 43, Kennedy was the youngest man ever elected president. Yet, the irony is that President Kennedy had one of the most complicated medical histories of anyone who ever held office, spending much of his term in Washington, and the years leading up to it, with a tenuous grip on several potentially debilitating conditions.

The crux of the story is the diagnosis of Addison’s disease that Kennedy received in 1947 at the age of 30 years, according to several reports, including a paper published by Lee R. Mandel, MD, MPH, Captain in the United States Navy Medical Corps, (Ret.). English physician and scientist, Thomas Addison, first proposed this polyendocrine syndrome in 1849, and then published a paper in 1856 that described the “suprarenal capsules,” which are now known as the adrenal glands.

Patients with this condition have adrenal glands that fail to produce cortisol and aldosterone and can experience fatigue, dizziness, muscle weakness, weight loss, difficulty standing up, nausea and sweating as well as changes in mood and personality.

But perhaps the most telling sign of the disease is on the outside, according to Adam J. Brown, MD, associate staff physician in the department of rheumatic and immunologic diseases at Cleveland Clinic, who discussed the topic on the Healio Rheuminations podcast. “Dr. Thomas Addison had quite an interest in the skin, which proved very useful, as he recognized the cutaneous features of adrenal insufficiency,” Brown said. “Importantly, all of these patients had hyperpigmentation of the skin.”

Ironically, then, President Kennedy’s famous suntan was the sign not of a fit and outdoorsy man, but of something much darker and more dangerous.

Keeping a Lid on

President Kennedy’s earliest forays into the political sphere were marked by health scares. He collapsed after a parade in Boston while running for Congress in 1945, with aides later remarking that he “turned yellow and blue,” according to Mandel.

After collapsing on a visit to England in 1947, the diagnosing physician commented to a friend of Kennedy’s, “That young American friend of yours, he hasn’t got a year to live,” Mandel reported. Yet, the story the Kennedy camp told the public regarding the incident in England was that it was a recurrence of the malaria he contracted while stationed in the Pacific during World War II. Kennedy subsequently began treatment with the synthetic adrenal hormone desoxycorticosterone acetate (DOCA). By 1950, when cortisone became more widely available, Kennedy added a 25-mg dose to his daily regimen.

In 1954, the future president underwent back surgery to relieve his persistent back pain, despite the potential complications that could have arisen from his diagnosis of Addison’s disease. In fact, he was plagued by back problems throughout his life, which adds another layer of complexity to his health history.

But this surgery was not the only complication that arose during the mid-1950s. He was diagnosed with hypothyroidism during a hospitalization in New York in 1955, and it has been reported that he underwent therapy with liothyronine throughout his presidency. Perhaps more importantly, many subsequent clinicians who have gained familiarity with Kennedy’s medical records have determined that the most appropriate over-arching diagnosis for his myriad endocrine complications is autoimmune polyendocrine syndrome type 2 (APS 2).

All of this led the future President’s political opponents, during the 1960 campaign, to raise questions about both the Addison’s disease as well as the possibility of a systemic cover-up by the Kennedy camp. This is where an association between Addison’s disease and tuberculosis comes into play; while nearly 80% of Addison’s disease cases are the result of an autoimmune etiology — which was the case in President Kennedy — tuberculosis is associated in about 10% of cases.

“During the Presidential election of 1960, obviously, he did not want people to know he had Addison’s disease, but the media got wind of the possibility, so they asked his brother, Robert F. Kennedy, for a statement,” Brown said.

In the statement, Robert Kennedy noted that his brother “does not now nor has he ever had an ailment described classically as Addison’s disease, which is a tuberculose [sic] destruction of the adrenal gland,” according to historical reports.

“See how wily he is there?” Brown said. “He is not denying that he had Addison’s disease. He is denying that he had Addison’s disease caused by tuberculosis. He is not exactly lying here, but it sounds like he is saying that JFK did not have Addison’s disease, when he actually did.”

This statement was enough to compel the future president’s opponents to drop this facet of their attack. – by Rob Volansky

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About the writer(s):

For more information:
Adam J. Brown, MD, can be reached at 9500 Euclid Avenue, Cleveland, OH 44195.
Lee R. Mandel, MD, MPH, can be reached at Health Services Department, H Division, USS George H.W. Bush (CVN 77), FPO AE 09513-2803; e-mail, mandellr@cvn77.navy.mil.

References:
Mandel LR, et al. Ann Intern Med. 2009; doi:10.7326/0003-4819-151-5-200909010-00011.

Disclosure: Brown and Mandel report no relevant financial disclosures.