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Late-onset triple A syndrome: a risk of overlooked or delayed diagnosis and management.
[triple a syndrome]
A
33
-
year
-old
man
was
referred
for
the
first
time
to
the
Division
of
Neurology
because
of
the
presence
and
progression
of
neurological
symptoms
.
Dysphagia
,
weakness
,
reduced
tear
production
,
and
nasal
speech
were
present
.
In
order
to
point
the
attention
of
late-onset
triple
A
syndrome
we
describe
this
case
and
review
the
literature
.
Hormonal
and
biochemical
evaluation
,
Schirmer
test
,
tilt
test
and
genetic
testing
for
AAAS
gene
mutations
.
Late
-onset
triple
A
syndrome
caused
by
a
novel
homozygous
missense
mutation
in
the
AAAS
gene
(
A
167
V
in
exon
6
)
was
diagnosed
at
least
17
years
after
symptom
onset
.
The
association
between
typical
signs
and
symptoms
of
triple
A
syndrome
should
suggest
the
diagnosis
even
if
they
manifest
in
adulthood
.
The
diagnosis
should
be
confirmed
by
Schirmer
test
,
endocrine
testing
(
both
basal
and
dynamic
)
,
genetic
analysis
,
and
detailed
gastroenterological
and
neurological
evaluations
.
Awareness
of
the
possible
late
onset
of
the
disease
and
of
diagnosis
in
adulthood
is
still
poor
among
clinicians
,
the
acquaintance
with
the
disease
is
more
common
among
pediatricians
.
The
importance
of
an
adequate
multidisciplinary
clinical
approach
,
dynamic
testing
for
early
diagnosis
of
adrenal
insufficiency
and
periodical
reassessment
of
adrenal
function
are
emphasized
.
Diseases
Validation
Diseases presenting
"dysphagia"
symptom
alexander disease
cadasil
cushing syndrome
dedifferentiated liposarcoma
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
inclusion body myositis
kindler syndrome
liposarcoma
locked-in syndrome
neuralgic amyotrophy
oligodontia
triple a syndrome
well-differentiated liposarcoma
This symptom has already been validated