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[Allgrove's syndrome].
[triple a syndrome]
Triple
A
syndrome
is
an
autosomal
recessive
disease
causing
achalasia
,
alacrima
and
adrenal
involvement
with
isolated
glucocorticoid
deficiency
.
Less
than
70
cases
have
been
reported
worldwide
.
We
report
a
case
of
familial
adrenal
insufficiency
with
hyperpigmentation
diagnosed
in
a
14
month
-old
child
.
A
2
year
-old
boy
,
a
product
of
consanguineous
parents
,
was
referred
to
our
institution
for
evaluation
of
melanoderma
.
Since
birth
the
boy
had
suffered
from
vomiting
and
diarrhea
.
Aged
6
months
,
mucosal
erosive
lesions
had
appeared
associated
with
fever
and
further
complicated
at
the
age
of
one
year
by
alacrima
.
At
the
age
of
14
months
,
hyperpigmentation
of
all
the
skin
had
occurred
.
The
family
history
is
significant
:
two
siblings
(
a
girl
and
a
boy
)
died
of
hypoglycemia
with
melanoderma
and
alacrima
at
the
age
of
5
and
3
respectively
.
Physical
examination
showed
generalized
hyperpigmentation
particularly
marked
on
the
lips
and
genitalia
.
The
genitalia
of
our
patient
were
normal
.
Cortisol
was
23
.
7
microns
/
l
(
normal
:
193
-
772
)
;
ACTH
was
11
,
722
pg
/
ml
(
normal
:
10
-
60
)
and
computed
tomography
of
the
abdomen
confirmed
adrenal
gland
hypoplasia
.
Treatment
was
initiated
with
hydrocortisone
at
the
dose
of
10
mg
/
day
.
At
the
age
of
3
,
the
boy
developed
plantar
hyperkeratosis
.
When
solid
food
was
introduced
,
vomiting
and
regurgitation
increased
.
An
oesophagogram
with
fibroscopy
revealed
achalasia
of
the
cardia
.
This
was
successfully
corrected
by
surgery
.
Schimer
's
test
confirmed
alacrima
.
Our
case
report
,
characteristic
of
triple
A
syndrome
,
is
unusual
in
view
of
the
presence
of
plantar
keratoderma
and
absence
of
any
neurological
abnormalities
.
Diseases
Validation
Diseases presenting
"adrenal insufficiency"
symptom
adrenal incidentaloma
adrenomyeloneuropathy
aromatase deficiency
congenital adrenal hyperplasia
cushing syndrome
familial hypocalciuric hypercalcemia
neonatal adrenoleukodystrophy
scrub typhus
triple a syndrome
von hippel-lindau disease
x-linked adrenoleukodystrophy
This symptom has already been validated