Cathy, I'm saddened to hear about your sister. I have salt wasting CAH and I know from personal experience that CAH is both a managable condition and is not intrinsicly a cause of poor health. It sounds as though your sister may be learning about the nature of her condition for the first time. That is certainly good reason to be depressed; it makes me depressed just thinking about it. Depressed and also angry. Didn't any of her doctors ever discuss her condition with her? You are a wonderful sister to be so concerned about her but why did it fall on you to be the one to tell her the name of her condition? If she doesn't even know what she has how could she be expected to take charge of her own health? OK enough venting. Would she be interested in learning about CAH as well as some things she can do to deal with her overweight? The very first thing she needs to do is have her 17-OH levels checked. Over suppression can be one cause of weight gain. She should probably also be checked for any other health problems such as diabetes or an underactive thyroid. Once those possibilities are ruled out I can offer her advice on exercise and nutrition to help her gain control over her health provided she has the motivation to act. In the mean time she should look through the links to medical sites that are listed on this board. Some of the information may be too technical but she doesn't need to read everything she just needs to get an overview. Encourage her to read about CAH and if she has questions the members of this board, myself included, will be glad to try to answer them as well as offer her emotional support. A while back I posted a capsule explanation of CAH. Here's a revised version of that information for your sister. CAH stands for Congenital Adrenal Hyperplasia. Congenital meaning from birth. Adrenal refers to the adrenal glands, a pair of tiny organs located atop the kidneys. Hyperplasia means the adrenals are enlarged. The enlargement is caused because of the inabitity of the adrenals to synthesize cortisol. The pituitary gland senses the low or absent cortisol and produces a hormone called ACTH which signals the adrenals to get to work making more cortisol. The adrenals try and fail. This constant stimulation of the adrenals causes them to enlarge. Normally cortisol is produced in a twenty four hour cycle with a peak just before dawn, a slow decline during the day and a low just after midnight before starting to surge toward the predawn peak. In addition, during times of physical or emotional stress the adrenals will produce extra cortisol independent of this 24 hour cycle. In addition to a cortisol deficiency, some people with CAH also don't produce sufficient aldosterone. Aldosterone is a hormone that keeps the body from losing sodium (salt). This condition of aldosterone deficiency is referred to as salt wasting. One of the first symptoms of a salt wasting crisis is vomiting. This can quickly spiral out of control since once vomiting starts it is impossible to keep down salt, water or medication. At that point medication must be administered by injection and it may also be necessary for glucose and saline to be given intravenously . In about 90% of the cases of CAH, when the adrenals try and fail to make cortisol, a hormone called 17-OH-progesterone accumulates. This is because an enzyme needed to convert 17-OH-progesterone into cortisol is faulty. Diagnostic tests for CAH involve administering ACTH to the patient. ACTH should cause cortisol levels to elevate. If 17-OH-progesterone is elevated instead it is an indication of probable CAH. Monitoring of patient status will include testing for 17-OH-progesterone in the blood or urine. CAH is managed on a day to day basis by taking some form of glucocorticoid such as hydrocortisone, predisone or dexamethasone. For infants and very young chidren this may be in a liquid form. When the child gets older the medication is the form of tablets. Generally two or three doses are taken per day. The outlook for well managed CAH is excellent. However there is always the danger in infants and small children who can't communicate that something is wrong that an adrenal crisis will occur. This requires prompt administration of cortisol by injection and possibly hospitalization. Many CAH patients have never had an adrenal crisis but the possiblitity is always there. It is obvious that you love your sister and I hope that your post on this board is just the first step toward helping her regain control over her health and her life. Joan