Peg, This may shed some more light on your experience with cortisone acetate. Some CAH patients need very high levels of cortisone acetate or don't respond to it at all. This is because cortisone acetate must first be converted to cortisol (hydrocortisone) in the body by an enzyme called 11-beta-hydroxysteroid dehydrogenase (11-Beta-HSD). I found a report of a case of a girl with CAH who did not respond to cortisone acetate because, in addition to her 21-hydroxylase deficiency, she also had an 11-Beta-HSD deficiency so that her body was unable to convert cortisone acetate into cortisol. Like yours, that story had a happy ending, she was put on hydrocortisone and her levels dropped. That report, which includes an explanation of the difference between hydrocortisone and cortisone acetate in the treatment of CAH, is at: http://endo.edoc.com/free_sample/jcem/v84n4/1210.html Joan