John F. Kennedy had the most complex medical history of any U.S. president, likely had polyendocrine syndrome type II

From the Annals of Internal Medicine:

In an Era of Less Media Scrutiny, John F. Kennedy Hid Serious Health Problems from the Public.

At the age of 43, he was the youngest man ever elected president. During his campaign and presidency, the media portrayed him as the epitome of youth and vigor. However, a recent review of his medical records reveals that Kennedy had the most complex medical history of any U.S. president.

Unbeknownst public, Kennedy was diagnosed with Addison's disease, a rare endocrine disorder in which the adrenal glands do not produce enough of the hormone cortisol.

Later, when Kennedy was a senator, he was found to have hypothyroidism. During the 1960 campaign for the presidency, Kennedy's physician denied the Addison's diagnosis.

Today, with newly available evidence, researchers can plausibly conclude that Kennedy had a rare unifying endocrine disorder called autoimmune polyendocrine syndrome type II, or APS II, which is characterized by the coexistence of hypothyroidism and Addison's disease.

Autoimmune polyendocrine syndromes in Essentials of clinical immunology By Helen Chapel:



Autoimmune polyendocrine syndrome type II (also known as Schmidt's syndrome) may include:

- Addison's disease
- Hypothyroidism
- Diabetes mellitus (type 1)
- Hypogonadism
- Vitiligo

Autoimmune polyendocrine syndrome type I (also known as Whitaker syndrome) may include:

- Chronic mucocutaneous candidiasis (CMC)
- Hypoparathyroidism and parathyroid autoantibodies
- Addison’s disease and antibodies to steroidogenic enzymes
- Hypergonadotropic hypogonadism
- Insulin-dependent diabetes mellitus
- Autoimmune thyroid diseases
- Lymphocytic hypophysitis or pituitary defects
- Pernicious anemia
- Chronic atrophic gastritis
- Malabsorption
- Chronic hepatitis
- Vitiligo

The 3 major components of polyglandular autoimmune syndrome, type I, are (1) chronic mucocutaneous candidiasis, (2) hypoparathyroidism, and (3) autoimmune adrenal insufficiency. The presence of all 3 components is not required to make a diagnosis; at least 2 components have to be present in an individual.

APS type III, although ill defined, is the co-occurrence of autoimmune thyroid disease with 2 other autoimmune disorders, including diabetes mellitus type 1, pernicious anemia, or a nonendocrine, organ-specific autoimmune disorder in the absence of Addison disease.

Comparison of different APS in Basic and clinical endocrinology By Francis Sorrel Greenspan, David G. Gardner:



References:

Endocrine and Autoimmune Aspects of the Health History of John F. Kennedy. Lee R. Mandel, MD, MPH. Ann Int Med. 1 September 2009 | Volume 151 Issue 5 | Pages 350-354.
Polyglandular Autoimmune Syndrome, Type I. eMedicine.
Polyglandular Autoimmune Syndrome, Type II. eMedicine.
Autoimmune Polyglandular Syndrome Type 1. C. Betterle, N. A. Greggio and M. Volpato. The Journal of Clinical Endocrinology & Metabolism Vol. 83, No. 4 1049-1055, 1998.
The Presidents Club | Photos: Oval Office Secrets from Truman to Obama | TIME, 2012.
Image source: John F. Kennedy, Wikipedia, public domain.

1 comment:

  1. Here is a link to more information about the genetics of Autoimmune Polyglandular Syndrome Type 1 that was prepared by our genetic counselor and which has links to some useful resources for those dealing with this condition: http://www.accessdna.com/condition/Autoimmune_Polyglandular_Syndrome_Type_1/51. There is also a phone number listed if you need to speak to a genetic counselor by phone. I hope it helps. Thanks, AccessDNA

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