70 yo WM, no PMHx (reportedly extremely healthy), presents with delusions of grandeur, impulsivity, confabulation, insomnia, paranoia. Denies EtOH. Denies meds. Reportedly high functioning (not verified). Previous business executive. Exam positive for orange discolored skin, grimaced facial expression, brachydactyly, abnormal hand movements, mild truncal obesity. No labs available.