Triple A Syndrome-A Rare Hereditary Cause of Achalasia

Triple A syndrome (TAS) is a rare disorder inherited in an autosomal recessive manner. It is characterized by the triad of alacrimia, achalasia, and adrenal insufficiency. It is caused by mutations in the AAAS gene (achalasia-addisonianism-alacrima syndrome), which disrupts the protein ALADIN (Alacrima-Achalasia-Adrenal insufficiency Neurologic disorder protein), which plays an important role in nucleocytoplasmic transport and cellular stress response. Unlike the presented cases, most patients with TAS present in early childhood with various symptoms including dry eyes, difficulty swallowing, and recurrent infections in addition to signs of adrenal crisis such as hypotension, hypoglycemia, and hyperpigmentation. Diagnosis can be achieved by genetic testing, revealing the mutations in the AAAS gene. Management of TAS mainly focuses on addressing each condition separately such as prescribing artificial tears for alacrimia, glucocorticoid replacement therapy for adrenal insufficiency, and performing pneumatic dilation or surgical intervention for achalasia. Early diagnosis is crucial for improving quality of life and minimizing the morbidity and mortality linked to the syndrome.