ProHealth
Questionnaire: Adrenal Burnout or Just a Bad Day?

The following questionnaire will help determine whether or not you could possibly be experiencing adrenal insufficiency (underactive function).

Circle the number that is most appropriate for you. If the indication does not apply to you, then just leave it blank. If you experience that indication in a mild way, circle #1. That means you may experience that indication once or twice a month. Circle #2 for moderate symptoms, which means they may occur several times a month. Circle #3 for severe symptoms, which are symptoms that you are aware of almost constantly. Do not ask family members and friends if they think you have these problems. Do not overthink-try to answer these questions instantly. You should know at once if you have one of these indications.

Mild

Moderate

Severe

Chronic fatigue

1

2

3

Low blood pressure

1

2

3

Muscle weakness

1

2

3

Dizziness

1

2

3

Weak, rigid nails

1

2

3

Brown spots or bronzing of the skin, especially on the shins

1

2

3

Frequent hives

1

2

3

Arthritis

1

2

3

Respiratory disorders

1

2

3

Bowel disorders

1

2

3

Muscular and nervous exhaustion

1

2

3

Decreased perspiration

1

2

3

Constipation

1

2

3

Swollen ankles, especially in the P.M.

1

2

3

Crave salt

1

2

3

Allergies

1

2

3

Asthma

1

2

3

Bronchitis

1

2

3

Weakness after colds and flu

1

2

3

TOTAL:


RESULTS

After you've circled the correct numbers, add your score. If you have a score of 5-8, you may have a mild case of adrenal insufficiency. A score of 8-12 may indicate a moderate case, and 12 or over is highly indicative of a severe case of adrenal insufficiency.

Printed From: http://www.prohealth.com/library/showarticle.cfm?libid=19109