Adrenal Disorders Patient Progress Tracking Chart

Patient Information

• Name: _________________
• Date of Birth: _________________
• Diagnosis: _________________
• Treating Physician: _________________

Daily Symptom Tracking

Rate severity (0-10, 0=none, 10=severe)

Physical Symptoms

• Fatigue Level: ___
• Muscle Weakness: ___
• Dizziness: ___
• Blood Pressure: /
• Weight Changes: ___ lbs
• Salt Cravings: ___

Medication Record

• Medication Name: _________________
• Morning Dose: ___mg
• Afternoon Dose: ___mg
• Evening Dose: ___mg

Stress Dose Documentation

• Date: _________________
• Reason for stress dose: _________________
• Additional dose taken: ___mg

Monthly Assessments

Laboratory Values

• Cortisol: ___
• ACTH: ___
• Aldosterone: ___
• Electrolytes: ___

Quality of Life Indicators

• Sleep Quality (0-10): ___
• Energy Level (0-10): ___
• Exercise Tolerance (0-10): ___

Notes

Emergency Contact Information

• Physician: _________________
• Emergency Contact: _________________
• Hospital Preference: _________________

Bring this chart to all medical appointments