title: Clinical and manometric characteristics of Allgrove syndrome.
abstract: OBJECTIVE
  The association of adrenocorticotropic hormone (ACTH) insensitivity with achalasia and alacrimia (Allgrove syndrome, 3A) constitutes a rare multisystem disorder. Its evolution is not well known. The aim of this study was to describe clinical and esophageal manometric characteristics and outcomes in Allgrove syndrome.
  
  
  METHODS
  This multicenter retrospective study compared clinical and manometric characteristics at diagnosis and on follow-up of 9 children presenting with 3A (mean age at diagnosis 7.1 years) with those of 9 children with idiopathic achalasia (IA) (mean age at diagnosis 8.3 years).
  
  
  RESULTS
  At the time of diagnosis, 3 children with 3A presented with no digestive or respiratory signs because they were identified during a family screening; 1 remained asymptomatic 8 years later. ACTH levels were high in patients with 3A. All of the patients with IA were symptomatic at diagnosis. No significant difference was observed when comparing any of the manometric parameters of the first esophageal manometry of 3A with those of IA. Seven children with 3A were operated on using the Heller procedure, completed by pneumatic esophageal dilation in 2 of these 7. One patient with 3A was treated only by nifedipine. Failure of treatment was observed in 3 children with 3A and 1 child with IA, partial success in 4 with 3A and 1 with IA, and total success in 2 with 3A and 7 with IA (P < 0.03). Control manometry showed that in the 3A group, partial success after surgery was always associated with abnormally low or normal lower esophageal sphincter (LES) pressure, whereas failure after surgery was associated with high LES pressure.
  
  
  CONCLUSIONS
  Our data showed that 3A presented a more severe course than IA despite presymptomatic diagnosis in cases of family screening. The high LES pressure noted in some patients with 3A is suggestive of a peculiar pattern in 3A affecting the LES and the lower part of the esophagus.
authors.affiliation: Department of Pediatric Gastroenterology, Hepatology, and Nutrition, and Reference Center for Congenital and Malformation Esophageal Diseases, Jeanne de Flandre University Hospital, Lille, France. Bakrhilal@yahoo.com
authors.forename: Bakr
authors.initials: B
authors.lastname: Alhussaini
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gottrand
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Goutet
authors.forename: Michèle
authors.initials: M
authors.lastname: Scaillon
authors.forename: Laurent
authors.initials: L
authors.lastname: Michaud
authors.forename: Claire
authors.initials: C
authors.lastname: Spyckerelle
authors.forename: Sheila
authors.initials: S
authors.lastname: Viola
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Lamblin
mesh_terms: D000309:Adrenal Insufficiency / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004931:Esophageal Achalasia / Q000503:physiopathology*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D012189:Retrospective Studies