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Endocrine testing confirmed autoimmune PAI, and corticosteroid plus mineralocorticoid replacement led to rapid resolution of psychiatric and systemic features. Recognising bedside clues such as hyperpigmentation, weight loss, anorexia and salt craving should prompt early endocrine work-up in psychiatric presentations, allowing swift diagnosis and obviating extensive investigations.<\/jats:p>","DOI":"10.1136\/bcr-2025-268064","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T08:40:15Z","timestamp":1766133615000},"page":"e268064","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Adrenal insufficiency presenting with psychosis"],"prefix":"10.1136","volume":"18","author":[{"given":"Santosha","family":"Mantha","sequence":"first","affiliation":[{"name":"Endocrinology, Army Hospital Research and Referral, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachin","family":"Modi","sequence":"additional","affiliation":[{"name":"Endocrinology, Army Hospital Research and Referral, New Delhi, 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