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• Skin thin and dry or scaly, pigmentation of temples, red palms or fingertips, and cold clammy palms.

• Deep Tendon Reflexes are exaggerated.

• Lymph Gland inflammation of the neck (swelling, pain, or tenderness).

• Blood Pressure is usually low, and drops upon standing (105/60) and then elevated to (120 or 130/70 or 80) on reclining (postural or orthostatic hypotension). This change from low to higher when lying down may be the reason why many patients find it difficult to fall asleep. It is conducive to falling asleep to lie in a semi-reclining position for 15 or 20 minutes. Another way to describe postural hypotension is that there may be a sudden drop in blood pressure to below normal upon suddenly arising from bed, or from standing still, causing temporary darkening of vision, dizziness, light-headedness, faintness, or fainting.

• Body Conformation is of the thin muscle-type (this is called asthenic habitus). The typical person is also tall with an angular appearance but a shorter person may have what we call “signs of tallness” – a moderately long neck, an index finger longer than the 4th (ring) finger, and a 2nd toe longer than the big toe. There are long arms and legs, and the arm span is greater than the height.

• Hair is sparse on the body but there is usually a full head of fine and abundant hair. The typical person is blond and blue eyed, or red headed. A tall, thin blonde with skin allergies can be diagnosed immediately.

• Dentition shows crowded lower teeth with a high palatal arch (roof of mouth).

• Pain and tenderness over adrenal area of mid-back when pressure is applied (called Rogoff’s sign).

• Urination is either very frequent in small amounts or infrequent in large amounts. This person usually does not do well in the heat or in the summer, particularly in conditions of high temperature, high humidity, and low barometric pressure.

• Scanty perspiration (except under arms or hands and feet). This person may be a “salt loser” (the tendency is to lose salt and to retain potassium). The urine and perspiration of the salt loser is saltier than normal and there is consequently a greater salt concentration on the skin. Animals are attracted to the salt on the skin, and often the low adrenal patient will be a favorite of animals to lick.

• Ankle and/or Finger Swelling. John Tintera, M.D. was an early pioneer in recognizing and treating adrenal insufficiency. He wrote that salt is a diuretic and that hypoadrenocortics (patients with low adrenal cortex function) retain fluid because the body is trying to hold onto the salt. When enough salt is consumed, the body takes what it needs and excretes the rest. If the ankle edema is due to insufficient salt, the edema will usually disappear in three days after taking adequate salt. If it does not disappear in five to six days, potassium may also be needed. Vitamin B6 is also helpful for edema not only because it has a diuretic effect but also supports the adrenal cortex.