Peroral endoscopic myotomy followed by antireflux mucosectomy for gastroesophageal reflux in a rare case of Allgrove syndrome.

This report relates to two female children (identical twins) aged 13 years, one of whom presented with dysphagia, vomiting, nasal regurgitation, and weight loss. The other twin, in history, also had similar symptoms. Esophagogastroduodenoscopy, barium swallow, and esophageal manometry suggested type I achalasia in the former; the other had type II achalasia cardia. Both gave a history of hyperpigmentation of knuckles, under eyes and elbows. Serum cortisol levels were low, with elevated ACTH levels in one, while the other had preserved adrenal function. Their mother gave a history that neither had shed tears since birth (Positive Schirmer’s test). Both successfully underwent peroral endoscopic myotomy and had good improvement in symptoms. At three months, both developed gastroesophageal reflux which needed antireflux mucosectomy in one and the other responded to medical therapy. This is a rare case of Allgrove syndrome with multisystem disease, and early recognition is vital to improving survival rates.