Adrenal Fatigue Questionnaire/Quiz
The following questionnaire/quiz is a tool for helping to assess the possibility of adrenal gland dysfunction. This
questionnaire/quiz is not intended to replace the advice of your own Naturopathic Physician. And, it is not meant to replace
laboratory testing, but to be used in conjunction with other assessment methods to better determine overall adrenal function.
At the end of the questionnaire you will be taken to a page that will display your results.
Please check the answer that best matches your experience for each question.
There are a total of 83 short questions (needed for a more accurate survey).
1. I get dizzy or see spots when standing up rapidly from a sitting or lying position.
Pick from one of the choices below that best matches your answer to the question.
2. I urinate more frequently than others and may need to get up at night.
Pick from one of the choices below that best matches your answer to the question.
3. I feel as though I might faint or black out.
Pick from one of the choices below that best matches your answer to the question.
4. I have chronic fatigue.
Pick from one of the choices below that best matches your answer to the question.
5. I have mitral valve prolapse or get heart palpitations.
Pick from one of the choices below that best matches your answer to the question.
6. I often have to force myself in order to keep going.
Pick from one of the choices below that best matches your answer to the question.
7. I have difficulty getting up in the morning.
Pick from one of the choices below that best matches your answer to the question.
8. I have low energy before the noon meal (approximately 11:00 a.m.).
Pick from one of the choices below that best matches your answer to the question.
9. I have low energy in the late afternoon between 3:00-5:00 p.m
Pick from one of the choices below that best matches your answer to the question.
10. I usually feel better after 6:00 p.m.
Pick from one of the choices below that best matches your answer to the question.
11. I often feel the best late at night because I get a ‘second wind’
Pick from one of the choices below that best matches your answer to the question.
12. I have trouble getting to sleep.
Pick from one of the choices below that best matches your answer to the question.
13. I tend to wake up early (approximately 3:00 to 5:00 a.m.) and have trouble getting back to sleep.
Pick from one of the choices below that best matches your answer to the question.
14. I have vague feelings of being generally unwell for no apparent reason.
Pick from one of the choices below that best matches your answer to the question.
15. I have swelling in the extremities, such as the ankles
Pick from one of the choices below that best matches your answer to the question.
16. I need to rest after times of mental, physical, or emotional stress.
Pick from one of the choices below that best matches your answer to the question.
17. I feel more tired after exercise or physical exertion, either soon or the next day.
Pick from one of the choices below that best matches your answer to the question.
18. My muscles feel weak and heavy more than I think they should.
Pick from one of the choices below that best matches your answer to the question.
19. I have chronic tenderness in my back near the bottom of my rib cage.
Pick from one of the choices below that best matches your answer to the question.
20. I have a weak back and/or weak knees.
Pick from one of the choices below that best matches your answer to the question.
21. I have restless extremities.
Pick from one of the choices below that best matches your answer to the question.
22. I am allergic to many things, such as food, animals and pollens.
Pick from one of the choices below that best matches your answer to the question.
23. My allergies are getting worse
Pick from one of the choices below that best matches your answer to the question.
24. I get bags or dark circles under my eyes, which may be worse in the morning.
Pick from one of the choices below that best matches your answer to the question.
25. I have multiple chemical sensitivities
Pick from one of the choices below that best matches your answer to the question.
26. I have asthma or get regular bouts of bronchitis, pneumonia, or other respiratory infections.
Pick from one of the choices below that best matches your answer to the question.
27. I have dermatographism (a white line appears on my skin if I run my fingernail over it and persists for one minute).
Pick from one of the choices below that best matches your answer to the question.
28. I have an area of pale skin around my lips.
Pick from one of the choices below that best matches your answer to the question.
29. The skin on the palms of my hands and soles of my feet tends to be red/orange in color.
Pick from one of the choices below that best matches your answer to the question.
30. I tend to have dry skin.
Pick from one of the choices below that best matches your answer to the question.
31. I tend to get headaches and a sore neck and shoulders.
Pick from one of the choices below that best matches your answer to the question.
32. I am sensitive to bright light.
Pick from one of the choices below that best matches your answer to the question.
33. I frequently feel colder than others around me.
Pick from one of the choices below that best matches your answer to the question.
34. I have decreased tolerance for cold.
Pick from one of the choices below that best matches your answer to the question.
35. I have Raynaud’s syndrome (extremely cold hands/feet).
Pick from one of the choices below that best matches your answer to the question.
36. My temperature tends to be below normal when measured with a thermometer.
Pick from one of the choices below that best matches your answer to the question.
37. My temperature tends to fluctuate through the day.
Pick from one of the choices below that best matches your answer to the question.
38. I have low blood pressure.
Pick from one of the choices below that best matches your answer to the question.
39. I become hungry, confused, or shaky if I miss a meal.
Pick from one of the choices below that best matches your answer to the question.
40. I crave sugar, sweets, or desserts.
Pick from one of the choices below that best matches your answer to the question.
41. I use stimulants, such as tea or coffee, to get started in the morning.
Pick from one of the choices below that best matches your answer to the question.
42. I crave food high in fat and feel better with high-fat foods.
Pick from one of the choices below that best matches your answer to the question.
43. I need caffeine (chocolate, tea, coffee, colas) to get me through the day.
Pick from one of the choices below that best matches your answer to the question.
44. I often crave salt and/or foods high in salt, such as potato chips.
Pick from one of the choices below that best matches your answer to the question.
45. I feel worse if I eat sweets and no protein for breakfast.
Pick from one of the choices below that best matches your answer to the question.
46. I do not eat regular meals.
Pick from one of the choices below that best matches your answer to the question.
47. I eat fast-foods often.
Pick from one of the choices below that best matches your answer to the question.
48. I am sensitive to pharmaceutical or nutritional supplements.
Pick from one of the choices below that best matches your answer to the question.
49. I have taken steroid medications for a long term at high doses.
Pick from one of the choices below that best matches your answer to the question.
50. I have symptoms that improve after I eat.
Pick from one of the choices below that best matches your answer to the question.
51. I tend to be thin and find it difficult to put weight on.
Pick from one of the choices below that best matches your answer to the question.
52. I have feelings of hopelessness and despair or have been diagnosed with depression.
Pick from one of the choices below that best matches your answer to the question.
53. I lack motivation because I do not feel I have the energy to get things done.
Pick from one of the choices below that best matches your answer to the question.
54. I have decreased tolerance towards other people and tend to get irritated by them.
Pick from one of the choices below that best matches your answer to the question.
55. I get more than two colds or flus per year.
Pick from one of the choices below that best matches your answer to the question.
56. It takes me a long time to recover from illness.
Pick from one of the choices below that best matches your answer to the question.
57. I get rashes, dermatitis, eczema, psoriasis, or other skin conditions.
Pick from one of the choices below that best matches your answer to the question.
58. I have an autoimmune disease.
Pick from one of the choices below that best matches your answer to the question.
59. I have fibromyalgia.
Pick from one of the choices below that best matches your answer to the question.
60. I have had mononucleosis or been diagnosed with Epstein Barr virus.
Pick from one of the choices below that best matches your answer to the question.
61. I do not exercise regularly.
Pick from one of the choices below that best matches your answer to the question.
62. I have a history of large amounts of stress in my life.
Pick from one of the choices below that best matches your answer to the question.
63. I tend to be a perfectionist.
Pick from one of the choices below that best matches your answer to the question.
64. My health is negatively affected by stress.
Pick from one of the choices below that best matches your answer to the question.
65. I tend to avoid stressful situations for the sake of my health.
Pick from one of the choices below that best matches your answer to the question.
66. I am less productive at work than I used to be.
Pick from one of the choices below that best matches your answer to the question.
67. My ability to focus mentally is generally impaired.
Pick from one of the choices below that best matches your answer to the question.
68. Stressful situations hinder my ability to focus.
Pick from one of the choices below that best matches your answer to the question.
69. Stress causes me to become overly anxious.
Pick from one of the choices below that best matches your answer to the question.
70. I startle easily.
Pick from one of the choices below that best matches your answer to the question.
71. It can take me days or weeks to recover from a stressful event.
Pick from one of the choices below that best matches your answer to the question.
72. I tend to get digestive disturbances when tense.
Pick from one of the choices below that best matches your answer to the question.
73. I tend to get unexplained fears and phobias.
Pick from one of the choices below that best matches your answer to the question.
74. My sex drive is very low or non-existent.
Pick from one of the choices below that best matches your answer to the question.
75. My relationships at work and/or home tend to be strained.
Pick from one of the choices below that best matches your answer to the question.
76. My life contains insufficient time for fun and enjoyable activities.
Pick from one of the choices below that best matches your answer to the question.
77. I have little control over my life and I feel ‘stuck’.
Pick from one of the choices below that best matches your answer to the question.
78. I tend to get addicted easily to drugs, alcohol, or foods.
Pick from one of the choices below that best matches your answer to the question.
79. I suffer from post-traumatic stress disorder.
Pick from one of the choices below that best matches your answer to the question.
80. I have or have had an eating disorder.
Pick from one of the choices below that best matches your answer to the question.
81. I have gum disease and/or tooth infections or abscesses.
Pick from one of the choices below that best matches your answer to the question.
82. I have symptoms of premenstrual syndrome (PMS).
***This question applies to women only. If you are not a woman, check "Never" as an answer. ***
Pick from one of the choices below that best matches your answer to the question.
83. My periods are irregular and/or affected by stress.
***This question applies to women only. If you are not a woman, check "Never" as an answer. ***
Pick from one of the choices below that best matches your answer to the question.
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