He has been like that for as long as I can remember, but he really likes sport.  From what I understand cortisol is excreted in large amounts in response to stress or exertion.  Therefore I presume that if supply does not meet demand that a child with CAH is bound to expend what levels they have in something like cross country running---which is continuous.  But as it cannot be replaced without giving extra cortisol, the levels decrease.  I guess that is why some kids with CAH bounce back after illness so quick because they have had a couple of days of a boost.  I know my son does, and like Carol said, one minute he's deathly white and looking really sick and after a couple of doses of cortisol he's complaining of boredom and wants to go to school or go out and play with friends!  Sometimes, he's just took off for hours without my knowledge and when he's come back, I've had to give him a lecture because he'l have had all day off school feeling rough and then out playing like nothing ever happened and with more energy than ever!  I cringe thinking if the teachers saw him they would think I was bad for keeping him at home when there is hardly anything wrong with him---to look at so to speak---lol.

I guess some children suffer CAH to varying degrees and I think due to the salt wasting aspects on top of the above, some kids may get tired or have their levels affected more rapidly than others.  My son enjoys sport and recently decided to start playing roller hockey as he says he doesn't use up as much energy as he would in say in soccer.  Must be a lot to do with gliding along as opposed to the resistance in running---I have no idea---but he enjoys it.  I think these kids may be more prone to dehydration or low electrolyte levels after exerting themselves for long stretches of time, but no one ever advised me to give him a dose of cortisol after, which is what you would virtually need first before giving the drinks with the eletrolytes in. Maybe someone should get tests done after allowing a kid to do such a run and report the effects---would be interesting huh!

JH