Trying again! My little girl age 1 has saltwasting CAH. I have been looking up some stuff on the web recently about circadian rhythyms and the patterns that cortisol is usually secreted in. In a person without CAH, cortisol output increases in the later part of the night and reaches a peak at morning and then gradually falls through the day (with the odd dip here and there) to a low at night when asleep. Now I know that I am replacing the cortisol for my daughter but I am concerned that the replacement pattern my hospital wants bears so little relation to this circadian rhythym. It is bothering me especially because I know that Human Growth Hormone is released in a peak when we fall asleep and cortisol suppresses the output of HGH. Has anyone else looked at this stuff before? Could this be why there are the problems with short stature in CAH? Also we have to do blood spot profiles in the UK and check the 17 ohp levels over 24 hours. And my daughter's 17 ohp levels were fine except for the 8 am - noon slot when they were between 300 and 500. By bedtime they had dropped to around 20! I think this may be because she needs a larger cortisol dose in the morning and less in the evening ie the same amount but divided differently through the day. What does anyone else think??