President John F Kennedy's medical history: coeliac disease and autoimmune polyglandular syndrome type 2.

President John F. Kennedy (JFK) had a complex medical history that is now thought to be an autoimmune polyglandular syndrome type 2 with Addison's disease and hypothyroidism. He also had gastrointestinal symptoms from adolescence, which now fit well with coeliac disease. In addition, he had a chronic back problem, which contributed to a chronic pain syndrome. This review looks at JFK's various diseases and focusses on the history of coeliac disease, as well as its presentation. JFK's Irish ancestry supports the hypothesis of a coeliac disease started early in his youth.

History of the development of corticosteroid therapy.

The first clinical evidence that an extract of animal adrenocortical tissue could counteract human adrenal failure was demonstrated in 1930. As chemical analyses of cortical extracts proceeded, mainly in the laboratories of Kendall at the Mayo Clinic and Reichstein in Zurich, it became evident that there is not one cortical hormone, but that all are steroids. By 1940 it was understood that there are two categories: those that cause sodium and fluid retention and those that counteract shock and inflammation. Structurally the presence or lack of oxygenation at C11 on the steroid skeleton was critical. In 1948 the first patient with rheumatoid arthritis was treated with cortisone and soon thereafter other rheumatologic patients received cortisone or, to stimulate native cortisone production, ACTH. Oral and intra-articular administration of cortisone and hydrocortisone began in 1950-51. Several lines of research to produce cortisone semi-synthetically showed some success by 1952. Between 1954 and 1958 six synthetic steroids were introduced for systemic anti-imflammatory therapy. By 1960 all of the toxic effects of chronic corticosteroid administration had been described, as well as protocols to withdraw such drugs while minimising symptoms of cortical insufficiency. To enable use of lower corticosteroid dosages, companion use of non-steroidal anti-inflammatory drugs began in the late 1950s, with phenylbutazone the first. In the 1970s the introduction of methotrexate and other anti-metabolites further circumscribed the dosages and indications for corticosteroids in the rheumatic diseases.

Endocrine and autoimmune aspects of the health history of John F. Kennedy.

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. The recent opening of his White House medical records has provided researchers greater insight into the multiple medical conditions that afflicted Kennedy. A recent review of these records, coupled with other available sources, allows new understanding of his health history that can now be explained in the context of a unifying autoimmune endocrine disorder.

[Stress, cortisone and homeostasis. Adrenal cortex hormones and physiological equilibrium, 1936-1960]. / Stress, Cortison und Homöostase. Kunstliche Nebennierenrindenhormone und physiologisches Gleichgewicht, 1936-1960.

This article investigates the emergence of the concept of stress in the 1930s and outlines its changing disciplinary and conceptual frames up until 1960. Originally stress was a physiological concept applied to the hormonal regulation of the body under stressful conditions. Correlated closely with chemical research into corticosteroids for more than a decade, the stress concept finally became a topic in cognitive psychology. One reason for this shift of the concept to another discipline was the fact that the hormones previously linked to the stress concept were successfully transferred from laboratory to medical practice and adopted by disciplines such as rheumatology and dermatology. Thus the stress concept was dissociated from its hormonal context and became a handy formula that allowed postindustrial society to conceive of stress as a matter of individual concern. From a physiological phenomenon stress turned into an object of psychological discourse and individual coping strategies.

[Two 150 years anniversaries: Claude Bernard's internal environment and Addison disease]. / Dve stopadesátiletá výrocí: Claude Bernardovo vnitrní prostredí a Addisonova nemoc.

In 2005 two 150 years anniversaries, which essentially influenced the development of modern medicine will be celebrated. French physiologist Claude Bernard from College de France published his work "Lectures on Experimental Physiology, applied to medicine" and British medical doctor T. Addison described insufficiency of adrenal cortex, today known as Addison disease.

The conquest of Addison's disease.

BACKGROUND: A review of the understanding and treatment of adrenal insufficiency was undertaken to emphasize common themes in the history of endocrine disorders. METHODS: Literature survey. RESULTS: The presence of the adrenal glands, initially ignored by anatomists, was first described by Eustachius and later confirmed by Casserius. Bartholin identified the glands as ductless. In 1855, Thomas Addison described the clinical syndrome of adrenal insufficiency. Medullary hormonal effects were described by Oliver and Shäfer in 1895; epinephrine was isolated by Takamini, and the secretory patterns were characterized by Cannon. Cortical function was elucidated by Biedl and Stewart and Rogoff, and the first cortical hormones were synthesized by Reichenstein. Hormonal replacement therapy paved the way for the first bilateral adrenalectomy, which was performed in 1950. CONCLUSIONS: This review underscores the historical themes in endocrine diseases: discovery of the glands, identification of their hormonal products, use of the hormones for therapy, and biosynthesis for pharmacologic applications.

[Discovery of mineralocorticoid hormones]. / Découverte des hormones corticosurrénales.

In 1855, the clinical and anatomical observations of Thomas Addison brought the pathology of the adrenal glands to the attention of his fellow physicians. His description had such an impact that Trousseau proposed to call this condition by Addison's name. On the basis of experimental finding, Brown-Séquard declared that the "adrenal glands play an essential role in the preservation of life". Many therapeutic trials were made in vain to slow down the fatal course of the disease. The discovery of deoxycorticosterone by T. Reichstein in 1939 ensured the survival of patients with Addison's disease. Its treatment greatly improved when cortisone became available and could be associated with desoxycorticosterone. The Nobel prize for physiology and medicine was awarded to the authors of these important discoveries: two biochemists (E.C. Kendall and T. Reichstein) for their work on the adrenocortical hormones, and a rheumatologist (P.S. Henck) for the therapeutic use of cortisone. In 1955, T. Reichstein actively participated in the isolation and the synthesis of aldosterone, a powerful mineralocorticoid, the last hormone of the adrenal cortex to be discovered.

[History of corticotherapy]. / Histoire de la corticothérapie.

Corticosteroids emerged in the late 1940s, at a time when steroid chemistry began to offer new therapeutic approaches. Extractive chemistry (T. Reichstein), chemical synthesis (E.C. Kendall) and clinical investigations (P. Hench) were combined to result in the discovery of cortisone in 1948, leading to a long series of related derivatives. Besides their first applications to treat Addison's disease and rheumatic or inflammatory diseases, corticosteroids could easily correct many metabolic and functional symptoms. Fluoridation of the steroid skeleton allowed the development of more active and better tolerated molecules. Corticosteroids have revolutionized the treatment of allergic diseases or immunity troubles, graft rejection, many dermatological, respiratory, digestive, eye diseases, etc. It is used today in all areas of therapeutic.

[Thomas Addison and the adrenal gland]. / Thomas Addison en de bijnier.

The famous and beautifully illustrated monograph "On the Constitutional and Local Effects of Disease of the Suprarenal Capsules" was published by Thomas Addison in 1855. This was the first description of the disease that now bears his name. Thomas Addison provided the first real contribution to the knowledge of adrenal function after three centuries of non-productive speculation and is one of the founders of modern endocrinology.