President Kennedy's Addison's disease, which came to light only after his election in 1960, was most likely caused by a rare autoimmune disease, according to a Navy doctor who reviewed Kennedy's medical records. The disease, autoimmune polyendocrine syndrome type 2, or APS 2, also caused Kennedy's hypothyroidism, according to a report published Tuesday in the Annals of Internal Medicine.
Hard though it is to believe these days -- when a celebrity's smallest sneeze is analyzed -- Kennedy's family and advisors were able to keep his medical history virtually secret. Kennedy, at 43 the youngest president ever elected, was portrayed as healthy and vibrant. In reality, he suffered various problems controlled by a daily regimen of steroids and other drugs.
Addison's disease is characterized by the withering of the adrenal glands, which produce adrenaline and other hormones. Symptoms include fatigue, dizziness, muscle weakness, weight loss, difficulty standing up, nausea, sweating, and changes in mood and personality. Tuberculosis accounts for about 20% of cases; the rest are autoimmune in origin.
During the 1960 campaign, Kennedy's opponents said he had Addison's. His physicians released a cleverly worded statement saying that he did not have Addison's disease caused by tuberculosis, and the matter was dropped.
Kennedy collapsed twice because of the disease: once at the end of a parade during an election campaign and once on a congressional visit to Britain.
Kennedy was diagnosed with Addison's in the 1940s. In 1955 he was diagnosed with hypothyroidism, an insufficient output of thyroid hormones. Symptoms can include many of those associated with Addison's, as well as paleness, intolerance to cold, depression and a low heart rate.
Dr. Lee R. Mandel, a Navy Medical Corps endocrinologist in Chesapeake, Va., was allowed to review Kennedy's medical records at the John F. Kennedy Presidential Library & Museum last year, and he also corresponded with many of Kennedy's physicians.
Mandel concluded that the hypothyroidism and Addison's resulted from APS 2.
Mandel found that Kennedy took a host of drugs and other remedies during his presidency: 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 steroids he was taking.
One characteristic of autoimmune diseases such as APS 2 is that close relatives often are affected as well. Kennedy's younger sister Eunice had Addison's, and John F. Kennedy Jr., his son, suffered from Graves' disease, in which the thyroid is overactive.