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Presidential Maladies: JFK's adrenal disease
In honor of Presidents Day this month, we've asked MultiCare's health experts to look back at the ailments of past U.S. presidents, then offer their perspective on how these conditions might be treated differently today. Third in our series is John F. Kennedy and his Addison's disease.
The president: John F. Kennedy
The year: 1947
The malady: Addison’s Disease
Description: We all remember (or have seen enough photographs to feel like we remember) 35th President John F. Kennedy as young, tan and handsome. But beneath the seemingly healthy exterior was a serious medical condition kept secret from the public until 30 years after his death.
“At the age of 43 years, John F. Kennedy was the youngest man ever elected president. Throughout both his campaign and his presidency, he was portrayed as the epitome of youth and vigor. In fact, he had the most complex medical history of anyone to occupy the White House.” (Source: Endocrine and Autoimmune Aspects of the Health History of John F. Kennedy, Annals of Internal Medicine)
That glowing, perpetual tan often seen as a symbol of health was in fact just a symptom of Addison’s disease – a rare disorder in which the body’s immune system mistakenly attacks the adrenal glands, which produce cortisol and other hormones. Symptoms include changes in blood pressure or heart rate, chronic diarrhea, nausea, and vomiting, or loss of appetite, changes in skin color, extreme weakness and fatigue, mouth lesions, and salt cravings.
Kennedy was plagued by various ailments throughout his life, so much so that his family used to joke that mosquitoes took a great risk in biting him – that his blood was likely to kill them off. In his 46 years of life, Kennedy was hospitalized more than three dozen times, for injuries and illnesses ranging from scarlet fever to a ruptured disk in his back. He was diagnosed with Addison’s disease in 1947, but was able to conceal many of his health concerns throughout his public life.
Some historians believe Kennedy may also have suffered from celiac disease, a gluten sensitivity that can be associated with Addison’s disease, as one autoimmune disease increases risk for others.
How treatment is different today:
Today, as in Kennedy’s time, Addison’s disease is treated through cortisol replacement, says Barbara Marshall, MD, a pediatric endocrinologist at MultiCare Mary Bridge Children’s Hospital and Health Center. Adrenal insufficiency was widely described in the medical literature of the 1950s and 1960s both as autoimmune adrenal disease and also because it was a complication of tuberculosis.
The goal of cortisol replacement is to mimic natural cortisol production, without overdoing it. Too much cortisol can cause obesity, osteoporosis, and the appearance of “moon face." Replacement is typically given as 2-3 daily doses of oral hydrocortisone. Cortisol is one of the primary stress hormones in the body, so double or triple doses of cortisol replacement can be necessary during times of stress or illness. Sometimes mineralocorticoid (a type of steroid hormone that helps the body absorb sodium and water and regulates blood pressure) replacement is needed as well, to keep the body from losing too much salt and developing low blood pressure (hypotension).
MultiCare Health System offers endocrine care for both children and adults. MultiCare endocrinology specialists such as Marshall are trained to diagnose and treat hormone imbalances and problems by helping to restore the normal balance of hormones in the endocrine system.
Kennedy’s team worked hard to keep his health struggles a secret. By the time he was president he was taking 10 to 12 different medications each day – including the daily hormones required to maintain his Addison’s disease. Despite his aggressive regimen of medication and persistent health woes, physicians and historians who have studied his medical records alongside his record in office do not believe changes in his health had an impact on his decisions as president.
Even if he were running for election today rather than in 1960, Kennedy's Addison's disease would likely not prove an obstacle, say physicians. Even without modern advances, Kennedy's disease was well-controlled, a feat attributed to Kennedy's endocrinologist, Eugene Cohen, MD, "the brains behind the management of the disease." (Source: Rare Disorder Explains JFK’s Health Woes, American Medical News)
Read more: Gout and Grover Cleveland
Read more: A Modern Look at Woodrow Wilson's Stroke