Chris,

I know that article very well.  In fact, Dr. Rivkees is my son's endo---a wonderful doctor and all-around great guy! The article makes a very good case for using dexamethasone to achieve normal growth in CAH children, and achieving comparable, if not, better results than using hydrocortisone.  I seem to remember someone named "Jenni" on this site, who once mentioned that her endo had been asked to peer review an article on dex, growth, and CAH---I wonder if it was this one.  I've had this article for almost a year now, but I did notice, from the ncbi website, that it's just recently been published.

As I've mentioned before, I believe that dex's (in my opinion, undeserved) reputation for causing oversuppression in CAH children, comes from the fact that most doctors do not know how to properly dose it. If it is carefully and knowledgably used, it should have no more potential for causing overtreatment than a too big dose of HC.  Nick has been on both dex and HC, and I feel he is definitely better, and more easily, controlled on the dex---neither undersuppressed, nor oversuppressed.  I think "Jenni," in her previous post, also mentioned that more doctors were coming around to the fact that the issue with dex useage was knowing how to properly control it.

I have found that because dex is given only once a day, it actually does away with a lot of the guesswork of using HC (what is the optimal time to give meds.? how many pills/day?  do I wake my child up for dosing? how do I stress dose?  etc., etc., etc. ) and makes the job of treating CAH on a daily basis much easier.  I also feel that it was a factor (the fact that it is long-acting and stays in the system longer than HC) in keeping Nick out of the emergency room on Thanksgiving night.  He got the same stomach flu that everyone else has been getting, and ended up vomiting 6 times between midnight and 5 am, and developed a 102 1/2 degree temp in the process.  But he made it through just fine (knock on wood) and did not even need the solu-cortef. 

Now, some of that is probably just luck and some of that is because he is not a SW, but I do believe the dex in his system definitely played a part, because I know non SW's who immediately end up in the ER under these same conditions.  (Believe it or not, I remember our doctor telling us, early on, that none of his patients have ever needed a solu-cortef injection---and he's been treating CAH patients for close to 20 years.  How's that for a track record?)

Anyway, thanks for sharing this information, and for giving me my five (or more? sorry, so long) minutes on the soapbox.  Hope all is well with you!