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Two siblings with triple A syndrome and novel mutation presenting as hereditary polyneuropathy.
[triple a syndrome]
The
clinical
and
molecular
data
on
triple
A
syndrome
in
two
siblings
(
girl
3
.
5
Â
years
and
boy
5
.
5
Â
years
at
presentation
)
with
early
onset
of
neurological
dysfunction
are
described
.
Both
patients
showed
delayed
developmental
milestones
and
neurological
dysfunctions
(
motor
and
sensory
demyelinating
neuropathy
,
marked
hyperreflexia
,
calves
hypothrophy
,
pes
cavus
,
gait
disturbance
)
in
early
childhood
,
when
erroneously
diagnosed
with
hereditary
polyneuropathy
,
most
likely
Charcot-
Marie
-
Tooth
disease
.
After
a
severe
adrenal
crisis
in
the
younger
sister
at
the
age
of
3
Â
years
,
the
older
brother
aged
5
.
5
Â
years
was
also
evaluated
and
latent
adrenal
insufficiency
was
discovered
.
As
both
of
the
siblings
had
alacrima
,
hyperkeratosis
of
palms
,
cutis
anserina
,
and
nasal
speech
,
diagnosis
of
triple
A
syndrome
was
considered
.
Sequencing
of
the
AAAS
gene
detected
a
compound
heterozygous
mutation
consisting
of
a
novel
mutation
p
.
Ser
296
Tyr
(
c
.
887
C
>
A
)
in
exon
9
and
a
previously
described
p
.
Ser
263
Pro
(
c
.
787
T
>
C
)
missense
mutation
in
exon
8
in
both
siblings
.
In
conclusion
,
triple
A
syndrome
should
be
considered
in
patients
presenting
with
early
neurological
dysfunction
and
developmental
delay
.
Alacrima
as
the
earliest
and
most
consistent
clinical
sign
should
be
investigated
by
Schirmer
test
.
Patients
should
be
regularly
tested
for
adrenal
dysfunction
to
prevent
life-threatening
adrenal
crises
.
Diseases
Validation
Diseases presenting
"early childhood"
symptom
22q11.2 deletion syndrome
achondroplasia
alpha-thalassemia
aniridia
aromatase deficiency
benign recurrent intrahepatic cholestasis
canavan disease
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cystinuria
erythropoietic protoporphyria
fabry disease
gm1 gangliosidosis
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
papillon-lefèvre syndrome
proteus syndrome
pyruvate dehydrogenase deficiency
triple a syndrome
werner syndrome
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