Late-onset triple a syndrome: A risk of overlooked or delayed diagnosis and management

Andrea Salmaggi, Lucia Zirilli, Chiara Pantaleoni, Gabriella De Joanna, Francesca Del Sorbo, Katrin Koehler, Manuela Krumbholz, Angela Huebner, Vincenzo Rochira

Research output: Contribution to journalArticlepeer-review


Background/Aims: 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. Methods: Hormonal and biochemical evaluation, Schirmer test, tilt test and genetic testing for AAAS gene mutations. Results: Late-onset triple A syndrome caused by a novel homozygous missense mutation in the AAAS gene (A167V in exon 6) was diagnosed at least 17 years after symptom onset. Conclusions: 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.

Original languageEnglish
Pages (from-to)364-372
Number of pages9
JournalHormone Research
Issue number6
Publication statusPublished - Dec 2008


  • Allgrove syndrome
  • Glucocorticoid deficiency
  • Nuclear pore complex
  • Nucleoporin

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism


Dive into the research topics of 'Late-onset triple a syndrome: A risk of overlooked or delayed diagnosis and management'. Together they form a unique fingerprint.

Cite this