SKIN January 2019 Volume 3 Issue 1 Copyright 2018 The National Society for Cutaneous Medicine 114 COMPELLING COMMENTS Adrenal Insufficiency and its Presidential Touch Christopher Dallo, BS1, Benjamin Falck, BS1 1University of Texas Medical Branch School of Medicine, Galveston, TX Tall, tan, and handsome are three words that often come to mind when we describe the 35th President of the United States, John F. Kennedy. Kennedy’s ascendancy to presidency over Richard Nixon was historic as he won the national popular vote by a margin of over 118, 000 votes. The series of candidate debates held during that election cycle, dubbed the “Great Debates”, were similarly historic as they represent the first televised presidential debates in the nation’s history and played a critical role in Kennedy’s success. On September 26, 1960, the two candidates squared off in the CBS news station in downtown Chicago.1 Before air, both candidates declined any touch-ups from the CBS makeup artists. With the cameras live, the whole world was able to contrast Kennedy’s enviable skin against Nixon’s uninviting wan complexion and shabby stubble. Kennedy’s glowing skin may have been attributed to primary adrenal insufficiency – an autoimmune destruction of the adrenal gland that results in decreased cortisol levels. This relieves inhibition at the hypothalamus and indirectly stimulates the pituitary gland to increase the production of proopiomelanocortin (POMC), a precursor of adrenocorticotropic hormone and melanocyte-stimulating hormone (MSH). The inadvertent increase of MSH promotes melanin production, which leads to skin hyperpigmentation. This might justify Kennedy’s seductive tan, although sources later alleged that Kennedy was graced with touch-ups from his own team before entering the spotlight.1 JFK’s brother, Robert Kennedy, also came to his defense when he publicly stated during the campaign trail that his brother never had Addison’s disease, and had only suffered “some mild adrenal insufficiency” during the post-war period, which had since “corrected over the years.”2 Polls reported that more than half of the voters in the election were influenced by the Great Debates.1 JFK repeatedly denied having any form of adrenal disease throughout his presidential run, and boldly claimed himself as “the healthiest candidate for President in the country.”3 After his death however, his family members were reluctant to have pathologists examine his abdominal cavity during the autopsy.3 In 1992, nearly 29 years after his assassination, a pathologist from his post-mortem examination finally broke silence and confirmed that John F. Kennedy’s adrenal glands were not even visible.4 Conflict of Interest Disclosures: None. Funding: None. SKIN January 2019 Volume 3 Issue 1 Copyright 2018 The National Society for Cutaneous Medicine 115 Corresponding Author: Christopher Dallo, BS The University of Texas Medical Branch Galveston, TX chdallo@utmb.edu References: 1. Altman, L. K. (1992, October 06). THE DOCTOR'S WORLD; Disturbing Issue of Kennedy's Secret Illness. Retrieved March 29, 2018, from https://www.nytimes.com/1992/10/0 6/health/the-doctor-s-world- disturbing-issue-of-kennedy-s-secret- illness.html. 2. Brown, D. (1992, October 6). JFK’s ADDISON’S DISEASE. The Washington Post. History.com Staff. (2010). The Kennedy-Nixon Debates [Television broadcast]. In History. New York City, New York: A&E Networks. 3. Bumgarner, J. R. (1994). The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician's Point of View. Jefferson, NC: McFarland & Company. https://www.nytimes.com/1992/10/06/health/the-doctor-s-world-disturbing-issue-of-kennedy-s-secret-illness.html https://www.nytimes.com/1992/10/06/health/the-doctor-s-world-disturbing-issue-of-kennedy-s-secret-illness.html https://www.nytimes.com/1992/10/06/health/the-doctor-s-world-disturbing-issue-of-kennedy-s-secret-illness.html https://www.nytimes.com/1992/10/06/health/the-doctor-s-world-disturbing-issue-of-kennedy-s-secret-illness.html