Psychiatric findings may include:
(1) hallucinations or psychosis
(2) delusions
(3) depression, which may respond poorly to antidepressants
(4) aggressive or agitated behavior
(5) anxiety disorder
(6) disorientation or memory impairment
(7) mania
(8) catatonia
(9) self-mutilating behavior
(10) delirium
An EEG abnormality is present in the majority of (but not all) patients.
Clinical findings that should raise suspicion of the diagnosis:
(1) history of an autoimmune endocrine disorder, tuberculosis or cancer
(2) episodic nature with normal behavior between episodes
(3) concurrent clinical findings of Addison's disease, such as anorexia, fatigue, malaise, weight loss, myalgias, hypotension, skin hyperpigmentation, and thinning of axillary or pubic hair
(4) concurrent laboratory test findings seen in Addison's disease (hyponatremia, hyperkalemia, hyperchloremia, azotemia)
If the diagnosis of Addison's disease is suspected then serum testing (including ACTH, serum cortisol) should be performed.
