Adrenal Questionnaire

Read the statements below, decide on the level of severity or frequency of each sign or symptom, and choose the number that most accurately reflects how that statement applies to you. Notice that the last eleven symptoms have higher point values, as they are more significant.

I’m anxious and irritable; any kind of stress sets me off.
I get caught up in worries.
I’m more fearful than circumstances warrant.
I tend to feel guilty.
I bruise easily, and cuts are slow to heal.
I have elevated blood pressure.
I have high cholesterol with low HDL and elevated LDL.
I retain fluid.
I have food cravings and increased appetite.
I have hyperglycaemia (high blood sugar).
I have trouble sleeping.
I get mouth ulcers or cold sores.
I look older than my age.
I have memory and cognitive problems.
I’m losing muscle and I have muscle weakness.
I have thin skin.
I have stretch marks that aren’t from being pregnant.
I have excessive hair growth.
I feel light-headed and dizzy, especially when I’m under stress.
I have an unusually fast or pounding heartbeat.
I tend to breathe quickly.
I sweat a lot even when I’m not exercising.
I’m drinking more alcohol than I should.
I tend to get infections.
I’m not interested in sex.
I need to urinate more often than seems normal.
I tend to feel agitated or nervous.
I get heartburn.
I have headaches.
I get very restless.
My face or skin flushes easily.
My hands tremble.
I tend to have trouble breathing.
I get blurry vision.
I have thin extremities. My arms and legs seem to be wasting away.
I have a round, moon face.
I’ve gained weight around my stomach without changing my eating habits.
I’ve been diagnosed with osteopenia or osteoporosis.

For the rest of the questions, Check Yes or No.

I have eczema, psoriasis, or urticarial.
I have bowel problems such as irritable bowel syndrome or inflammatory bowel disease.
I have panic attacks.
I have an ulcer.
I have gastroesophageal reflux.
I have insulin resistance.
I have metabolic syndrome, or syndrome X.
I have type 2 diabetes.
I’ve been diagnosed with depression.
I have chronic or sever allergies.
I have a chronic health condition or illness.

Interpreting your results

If your score is between 8 and 12, you’re beginning to show signs of possible excess cortisol and adrenaline production. If your score is between 13 and 19, your condition is more serious. And if your score is over 19, you’ve probably experienced significantly elevated levels of cortisol and adrenaline on a chronic basis, which can affect your health and well-being. If your score is over 12 or if you have any of the last eleven serious symptoms, even if only to a mild degree or occasionally, make an appointment with a functional medicine practitioner/nutritionist/practitioner to have your adrenal function evaluated.

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