Introduction: Achalasia has been reported to be associated with various autoimmune diseases including myasthenia gravis, polymyositis, autoimmune thyroid disease, among others. It has been also linked with an autosomal recessive congenital disorder: achalasia-addisonianism-alacrimia syndrome, called Allgrove syndrome. This is a first case report of a combination of achalasia, Addison disease, and autoimmune thyroiditis. Case Report: A 53-year-old Caucasian male was admitted for dizziness with a BP of 88/60. He had 1-month duration of feeling fatigue, generalized body aches, weakness, and a weight loss of about 40 pounds. He also has been having trouble swallowing, particularly for liquids more than solids of about 6 to 7 years' duration. Over 1 week, he has been having frequent regurgitations. He has also a longstanding history of chronic cough, particularly when he lies down in supine position. He was also has been having increase skin pigmentation which he attributes to sun tanning. He had a normal sexual drive and libido, but states that he is constantly fatigued and unable to perform. He tends to have dizziness and unsteady gait in the mornings. He denied any dryness of his eyes, tear problems, or visual problems. Family history was significant with a paternal history of pernicious anemia in his father, who also had cancer of the stomach. Paternal grandfather also had cancer of the stomach. Maternal history of goiter, as do two of his nieces. He denied the use of any tobacco or illicit drugs and stated he rarely consumes alcohol. Investigations showed he had a TSH of 47.34 mcIU/mL and a free T4 of 0.6 ng/dL. Initial blood glucose was 67 mg/dL. His cortisol level was persistently less than 1.0 mcg/dL. ACTH was elevated at 733pg/mL. He had a positive ACTH stimulation test. Thyroid peroxidase antibodies was positive at 331pg/mL including a 21 hydroxylase antibody which was positive at 2543 U/mL. His CPK enzymes were normal. He was finally diagnosed with adrenal insufficiency and hashimotos's thyroiditis. He was started on fludrocortisone, hydrocortisone, and levothyroxine. His esophagogram showed marked luminal narrowing at the GE junction with bird beak configuration. Manometry showed type 2 achalasia. He finally had a laparoscopic Heller myotomy with bolstering partial anterior fundoplication. Since his management he improved and was more energetic with good weight gain and no dysphasia. Discussion: Among some rare association of genetic disorder and autoimmune conditions with achalasia this is the first reported syndrome of achalasia, Addison disease, and autoimmune thyroiditis.