Pain and last rites for John F. Kennedy

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Editor's note: In this presidential election year, Allan B. Schwartz, M.D., a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine, offers a different kind of Medical Mystery, looking at the health of U.S. presidents. Today, he starts the series with the 35th president, John F. Kennedy.

John F. Kennedy's public image was that of a healthy, vital, young man, elected president at just 43 years old. But he suffered from a variety of medical problems, hidden by the Kennedy family and staff. His mother, Rose, indicated that Jack had a back disorder due to a football injury and later aggravated by a now-famous 1943 incident in which his PT 109 was cut in two during an attack by a Japanese destroyer.

Lt. Kennedy led his surviving crew, swimming to a nearby island with a rope clenched between his teeth so he could rescue an injured crewman.

Kennedy developed increasing back pain, fever, and disability, and began losing weight, dropping from 160 to 125 pounds. He was shipped back from the Pacific to Chelsea Naval Hospital, Boston, in June 1944, and was later awarded the Navy and Marine Medal for "extremely heroic conduct." At the Lahey Clinic, he had his first back and spinal surgery for a ruptured spinal disk.

In 1946, during his campaign for Congress, Kennedy collapsed at an event and required emergency care for low blood pressure. The clinical description: "sweating heavily and skin discolored." In 1947, after diagnostic tests, doctors gave a prognosis of "No more than a year to live." That same year, he was given last rites.

What was Kennedy's condition that grew so severe he was administered the last rites then and two more times while traveling in London and Asia? What medicines were used to treat him as a congressman and later as U.S. president?

Solution:

The diagnosis for John F. Kennedy was adrenal gland failure, also known as Addison's disease. Both his right and left adrenal glands failed to produce enough of the adrenal hormones, cortisone and aldosterone, to sustain life.

Adrenal gland hormones maintain sodium, potassium and water balance, kidney function, blood pressure, cardiac and vascular function, glucose and metabolic balance. Addison's disease causes symptoms of tanned skin, sweating, weakness and low blood pressure, and can even cause loss of consciousness. In addition, Kennedy showed signs of insufficient thyroid hormone.

In 2009, a medical article by Lee Mandel, a former U.S. Navy physician, indicated Kennedy had "Autoimmune Polyendocrine Syndrome type 2 (APS 2)," also known as Schmidt's syndrome. Patients with APS 2 can also have abnormalities of other hormones produced in the testicles, pancreas, GI tract, and thyroid in addition to adrenal hormone deficiency. APS 2 can run in families.

(Mandel had reviewed previously hidden medical records now available in the John F. Kennedy Presidential Library and Museum in Boston.)

Kennedy's medicines included hydrocortisone 10 mg daily, prednisone 2.5 mg twice daily, methyltestosterone 10 mg daily, levothyroxine 25 mcg twice daily, fludrocortisone 0.1 mg daily.

Though the Kennedy campaign worked hard to keep his condition secret, his health did become an issue. U.S. Rep. Walter Judd of Minnesota, a physician and the 1960 Republican keynote speaker, raised the question.

"For one thing I would like a flat answer to rumors in medical circles that Case Number Three in the American Medical Association's Archives of Surgery, Vol. 71, relates to Senator Kennedy," Judd said, referring to a medical report of a patient with severely complicated spine surgery requiring adrenal hormone therapy. "If so, . . . Senator Kennedy is duty bound to make this fully available to the consideration of every voter."

Kennedy's physicians released this statement: "John F. Kennedy does not now nor has he ever had an ailment described classically as Addison's disease. . . . Any statement to the contrary is malicious and false."

The doctors were walking a fine semantic line here by denying Addison's when they knew very well that their patient had adrenal failure. But JFK's autoimmune form of Addison's was not then described as a "classic" form, which at that time referred to adrenal failure caused by tuberculosis or cancer.