I remember reading somewhere that people with CAH have a higher than average number of adrenal tumors, the vast majority of which are benign. I have some thoughts on why this might be the case. Hyperplasia is defined as enlargement of an organ due to an increased number of cells. Any cell in the body has the genetic information to become any type of cell. How an immature cell differentiates is determined by its immediate environment. In CAH the hyperplasia of the adrenals is caused by high levels of ACTH from the pituitary. When someone with CAH is not receiving adequate glucocorticoid therapy ACTH levels become elevated and adrenal cells are stimulated to grow and divide. If elevated ACTH affects cells within the adrenal glands, it may also be that it can also stimulate cells in the vicinity of the adrenals to grow and differentiate into adrenal cells causing the formation of a tumor. It is possible for a salt waster to survive without fludrocortisone by consuming adequate amounts of salt and water to replace what is lost. (see my responses to the 8/27/00 thread: "31 yr old taking florinef for the 1st time"). As to surviving without cortisol replacement therapy - only if one is extremely lucky, since the body needs cortisol in the event of a serious injury or illness. That is why it is so important that anyone with CAH wear a medical tag to inform medical personel of this condition. For a female, lack of cortisol replacement therapy also brings up the issue of virilization since 17-OH progesterone ultimately is converted to testosterone. Caroline, I can sympathize with your attempt to quit seeing doctors and taking medication but unfortunately your condition is too serious for this to be possible without taking life threatening risks. I too have classic, salt wasting 21OH CAH, but in my case it was diagnosed 50 years ago, shortly after birth. Please feel free to email me if you want to talk further. Joan