Athanasia Bouliari1, Xuexin Lu1, Rebecca W Persky2, Constantine A Stratakis1. 1. Eunice Kennedy Shriver National Institute of Child Health and Human Development, 10 Center Drive, Building 10, Room 1-3330, Bethesda, MD, 20892, USA. 2. Eunice Kennedy Shriver National Institute of Child Health and Human Development, 10 Center Drive, Building 10, Room 1-3330, Bethesda, MD, 20892, USA. Rebecca.persky@nih.gov.
Abstract
OBJECTIVE: 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. DESIGN: This is a case report of two siblings. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: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. DESIGN: This is a case report of two siblings. RESULTS: 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. CONCLUSIONS: 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.
Entities:
Keywords:
AAAS; Allgrove syndrome; Novel variant; Triple A syndrome
Authors: B P Brooks; R Kleta; C Stuart; M Tuchman; A Jeong; S G Stergiopoulos; T Bei; B Bjornson; L Russell; J-P Chanoine; S Tsagarakis; Lr Kalsner; Ca Stratakis Journal: Clin Genet Date: 2005-09 Impact factor: 4.438
Authors: Henry Houlden; Stephen Smith; Mamede De Carvalho; Julian Blake; Christopher Mathias; Nicholas W Wood; Mary M Reilly Journal: Brain Date: 2002-12 Impact factor: 13.501
Authors: A Tullio-Pelet; R Salomon; S Hadj-Rabia; C Mugnier; M H de Laet; B Chaouachi; F Bakiri; P Brottier; L Cattolico; C Penet; M Bégeot; D Naville; M Nicolino; J L Chaussain; J Weissenbach; A Munnich; S Lyonnet Journal: Nat Genet Date: 2000-11 Impact factor: 38.330
Authors: Janet M Cronshaw; Andrew N Krutchinsky; Wenzhu Zhang; Brian T Chait; Michael J Matunis Journal: J Cell Biol Date: 2002-08-26 Impact factor: 10.539