Adrenal Assessment


Welcome to the Adrenal Assessment! Please check off each statement that applies to you. Each is worth 1 point.

Name
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Markedly reduced ability to handle stress or pressure.

1 out of 38

Decreased cognitive ability. I don't think as clearly as I used to.

2 out of 38

Tend to avoid emotional situations.

3 out of 38

Often shake or feel nervous when under pressure.

4 out of 38

Nervous stomach or indigestion when tense.

5 out of 38

Unexplained fears/anxieties.

6 out of 38

Sex drive noticeably reduced.

7 out of 38

Get lightheaded or dizzy when rising rapidly from a sitting or lying position

8 out of 38

Chronic fatigue not usually relieved by sleep.

9 out of 38

Feel unwell much of the time.

10 out of 38

Swollen ankles—worse in the evening.

11 out of 38

New or increasingly severe allergic reactions.

12 out of 38

Feel weak all over.

13 out of 38

Decreased cold tolerance.

14 out of 38

Low blood pressure (under 105/65)

15 out of 38

Often hungry, confused, shaky, or somewhat paralyzed under stress.

16 out of 38

Lost weight without reason while feeling very tired and listless.

17 out of 38

People irritate me more.

18 out of 38

Lymph nodes in my neck frequently swollen.

19 out of 38

Extended, severe, or recurring respiratory infections.

20 out of 38

Frequently overwhelmed by normal life events.

21 out of 38

Worse if I skip a meal or go too long without eating

22 out of 38

Cry Easily

23 out of 38

Prescribed antidepressants/antianxiety drugs, but you know that is not the problem

24 out of 38

Tanned appearance (or brown spots) without being in the sun

25 out of 38

Exhausted but jittery, jump at loud noises

26 out of 38

Wide range of symptoms that mimic other illnesses or are unexplained by doctor

27 out of 38

I frequently get rashes, dermatitis, or other skin conditions

28 out of 38

I have allergies to several things in the environment.

29 out of 38

I have multiple chemical sensitivities.

30 out of 38

I have chronic fatigue syndrome.

31 out of 38

I have insomnia or difficulty sleeping.

32 out of 38

I have fibromyalgia.

33 out of 38

I suffer from nervous breakdowns.

34 out of 38

My allergies are becoming worse (more severe, frequent, or more diverse).

35 out of 38

My eyes are puffy underneath upon rising, but it goes away after I’ve been up a couple hours.

36 out of 38

(Women Only) I have increasing symptoms of premenstrual syndrome (PMS) such as cramps,
bloating, moodiness, irritability, emotional instability, headaches, tiredness, and/or intolerance
before my period (only some of these need be present).

37 out of 38

(Women Only) My periods are generally heavy but they often stop, or almost stop, on the
fourth day, only to start up profusely on the 5th or 6th day.

38 out of 38