JFK’s Addison’s probably caused by rare autoimmune disease

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John F. Kennedy’s Addison’s disease, which came to light only after his election as president in 1960, was most likely caused by a rare autoimmune disease, according to a Navy doctor who reviewed his medical records. The disorder, called autoimmune polyendocrine syndrome type 2 or APS 2, also caused Kennedy’s hypothyroidism, according to the report today in the Annals of Internal Medicine.

In today’s hyperactive media environment where the smallest sneeze of a celebrity is thoroughly analyzed, it is difficult to believe that Kennedy’s family and advisors were able to keep his medical history virtually a complete secret. The youngest man ever elected to the presidency at age 43, JFK was pictured as a healthy and vital young man. In reality, he suffered from a variety of problems that were kept in check only by a daily regimen of steroids and other drugs.

Addison’s disease is characterized by the withering away of the adrenal glands, which produce adrenaline and other hormones. Symptoms include fatigue, dizziness, muscle weakness, weight loss, difficulties standing up, nausea, sweating and changes in mood and personality. About 20% of cases are the aftermath of tuberculosis, and the rest are autoimmune in origin. During the 1960 campaign, Kennedy’s opponents argued that he had Addison’s, but his physicians released a cleverly worded statement saying that he did not have Addison’s disease caused by tuberculosis, and the matter was dropped.

JFK’s Addison’s was initially diagnosed in the 1940s, and he suffered two severe collapses as a result, once at the end of a parade during an election campaign and once on a congressional visit to Britain. Records reveal that in 1955 he was also diagnosed with hypothyroidism -- an insufficient output of thyroid hormones. Symptoms can include many of those associated with Addison’s, as well as a lack of tolerance for cold, paleness, depression and a low heart weight.

Dr. Lee R. Mandel, an endocrinologist in the U.S. Navy Medical Corps in Chesapeake, Va., was allowed to review Kennedy’s medical records at the John F. Kennedy Presidential Library & Museum last year*. After synthesizing the information in the records and conducting correspondence with many of Kennedy’s physicians, he concluded that both problems were the result of APS 2.

[*Correction: An earlier version said Dr. Lee R. Mandel accessed the records this year. According to the Annals of Internal Medicine report, he reviewed them in 2008.]

Mandel found that Kennedy, during his presidency, was taking a host of drugs daily: 500 milligrams of vitamin C twice daily; 10 milligrams of hydrocortisone daily; 2.5 milligrams of prednisone twice daily; 10 milligrams of methyltestosterone daily; 25 micrograms of liothyronine twice daily; 0.1 milligrams fludrocortisone daily; and diphenoxylate hydrochloride and atropine sulfate, two tablets as needed. Liothyronine is a synthetic thyroid hormone. Diphenoxylate/atropine, commonly known as Lomotil, is used to treat diarrhea. The testosterone was administered to combat the weight loss and gonadal atrophy associated with the other steroids he was given.

If Kennedy were a professional athlete, he would have been benched.

One characteristic of autoimmune diseases like APS 2 is that close relatives are often affected as well. It is well-known that JFK’s younger sister, Eunice, had Addison’s disease and that his son, John F. Kennedy Jr., suffered from Graves disease.

-- Thomas H. Maugh II