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Triple A syndrome: two siblings with a novel mutation in the AAAS gene

  • Athanasia Bouliari
  • Xuexin Lu
  • Rebecca W. Persky
  • Constantine A. Stratakis
Case Report



Triple A syndrome is a rare autosomal recessive disorder caused by mutations in the AAAS gene on chromosome 12q13. Its main clinical features are alacrima, achalasia, and adrenal insufficiency, with most patients also having neurological symptoms and autonomic dysfunction. The neurologic manifestations are less well-understood, especially in children. Here, we examine two siblings who were found to have a novel mutation in the AAAS gene and who were found to have subtle, but important, neurologic findings.


This is a case report of two siblings.


We discuss two siblings exhibiting different signs of the disorder including neurologic dysfunction found at varying ages. Genetic analysis revealed that both patients have the same compound heterozygous mutations in the AAAS gene consisting of one novel mutation (c.500 C>A, A167E) and one previously described mutation (c.1331+1G> A/IVS14+1 G>A). A diagnosis of triple A syndrome was reached based on their clinical and genetic findings.


The unique characteristic of these two cases is the novel mutation in the AAAS gene, which is likely pathogenic. In addition, they showcase the genotype-phenotype variability of the disease, as well as the importance of early identification of the neurologic abnormalities, which can result in early intervention and possibly improved outcomes.


Triple A syndrome AAAS Allgrove syndrome Novel variant 


Author contributions

All authors have accepted the responsibility for the entire content of this submitted manuscript and approved the submission.


This research was supported in part by the Intramural Research Program of the National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.


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Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019

Authors and Affiliations

  • Athanasia Bouliari
    • 1
  • Xuexin Lu
    • 1
  • Rebecca W. Persky
    • 1
  • Constantine A. Stratakis
    • 1
  1. 1.Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaUSA

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