The classic triad of triple A (Allgrove) syndrome

A 42-year-old patient was admitted with slowly progressive gait disturbance over a period of ten years. The patient complained of regurgitation and fatigue since childhood. Clinical examination revealed nasal voice, distal amyotrophic motor deficit with pyramidal signs, mild intellectual disability, increased skin pigmentation, and reduced body weight (BMI: 16.6 kg/m2). Schirmer test revealed bilateral alacrima and barium swallow confirmed achalasia cardia. Cortisol level was undetectable, while adrenocorticotrophic hormone was elevated.