Basically, when the docs refer to stress in most text they mean the ohysical type of stress that we go through at times of injury or illness.  However, it is coming more to the fore now that any kind of mental stress also causes a demand for cortisol which is well above what our childrens set dose of cortisol is when they are perfectly healthy and unstressed.  Even running over a pro longed period of time is going to cause a large amount of cortisol and possibly use up what little the child has in the blood I feel.  It's going to leave their cortiol levels pretty low and until they get their next dose I feel that leaves them open to androgen production on top of being more prone to other stresses haveing a detrimental effect.  However, that just my theory and some others have this too.  Imagine a hot day and your child is asked to do a 15 minute cross country run---and I feel that is enough of a stress to cause levles of cortisol to lower.  Mental stress over a very long period of time could also be a problem.  Let's say your child is being bullied at school every day and as each day goes by, they get that sick feeling in the pit of their stomach and that in itself is enough to get the adrenalin pumping.  Below is an extract from a web site that I cut and pasted for folks to read to tell you how this happens.  I feel that even falling in love and having that high that you feel over a long length of time could even effect cortisol levels which could lead to a low in adults with CAH.  

If your doctor was advising this I would say that he is a very understanding doctor that quite well knows all these things and is prepared to be straight and honest and tell you these things.  My doctor would say it is absolute hogwash---but I don't think he'd tell me even if he knew these things for fact.  The more that you can do to reduce stress ifor your child the better in that sense save wrapping them in cotton wool though.  By that I mean unnecessary stress like bullying at school or fighting with siblings, even scolding.  There are many ways to punish a child aside from scolding or corporal punishment.  These things only teach your child that it is okay to scold and hit people or hurt them physically.  Taking something they enjoy like a gameboy or keeping them off the pc for a few days or restricting their tv usage or grounding them or putting them in their room until they cool down=yes.  These are ways to do things that can make your child also appreciate that when you say no you mean no.  I guess everyone has their ways of dealing with kids, but more and more now corporal punishment and scolding are being shunned and we even have adverts here that show clips of children down the generations being scolded and smacked (in one family) until todays generation where they are still the same.  The message is strong and clear and is simple.  Someone has to break the cycle.   As kids we have had the odd smack---even from a teacher at school and I realise some people may say, "Well I had a few clips here and there and it never did me any harm."  Try asking yourself that when you next find yourself bawling at your kids for something---I always do just as I am about to and it kind of makes me think.   When a child is under suppressed as mine was for a long period of time, I would imagine it takes very little to help their levels get to much more serious levels.  That is because you have the deadly combination of stress on top of not enough cortisol daily to even deal with the normal every day things.  So don't be surprised if your child just cannot handle things on some days and does on other---or goes through a few weeks of not being to good at school followed by being ok.  Too much cortisol even affects cognitive learning and has toxic effects on the brain.  That is why it is so important for regular blood tests---as I keep arguing with my doctor here.  Anyway, here is that abstract to read:   

 

 

When God created human beings, He knew there would be times when we would meet danger and our bodies would need to react quickly so we could get to safety. So He gave each of us a hypothalamus gland. The hypothalamus, located in the brain, is very important— as it’s primary purpose is maintaining homeostasis, in other words, it maintains an internal stability . It is incredibly sensitive to the psychological and spiritual state of your body. When you’re at peace walking down a nature trail, the hypothalamus senses that peace, but the second you turn around the bend and come face to face with a mother grizzly bear growling at you, the hypothalamus senses the fear and goes into action. The hypothalamus doesn’t know why you’re scared as it doesn’t think for itself, it is only a gland. It only knows that you are scared out of your wits, so there must be some danger.

The hypothalamus has the job of transferring thought into chemistry. It does this by secreting the hormone, CRF, which causes a chain reaction of over 20 other hormones, and neurotransmitters to be released throughout the body. For instance, when the hypothalamus senses stress, fear and anxiety, it releases CRF. When the Sympathetic Nervous System (SNS) receives the CRF, it releases a hormone called norepinephrine and at the same time it stimulates a gland called the Adrenal Medulla to release epinephrine (adrenaline). These hormones alone effect just about every organ system of the body, for instance they cause your heart rate, blood pressure, blood sugar, blood fats, cholesterol in your blood and your metabolic rate to increase. At the same time muscular fatigue is delayed, blood supply to the bladder and intestines is reduced and their muscular walls relax. But that isn’t all, your digestive juice output, carbohydrate production, breakdown of cholesterol, and insulin production all decrease. They also cause the sphincters to contract (muscles that assist you in having a bowel movement). While epinephrine and norepinephrine are busy effecting the body, another gland, the Adrenal cortex, releases the hormone Cortisol (also known as hydrocortisone). Cortisol effects many areas of the body, such as the liver, digestive system, muscles, skin and bones, protein production, heart, blood levels of amino acids and it suppresses the immune system.

Imagine dozens of hormones and neurotransmitters all being released into the body and effecting pretty much all parts of the body in different ways every time your hypothalamus senses you are afraid.

If what you are afraid of is a charging grizzly bear, these reactions are beneficial as you frantically climb the nearest tree. If on the other hand, you are constantly stressed, frequently anxious, and have lots of fears, this biological process never stops, homeostasis never returns and the process can become fatal.

The Flight or Fight Stage is immediate, allowing us the needed energy to climb that tree. But when the fear is within, we soon enter the Resistance Stage— long term our bodies are geared up for stress (fear and anxiety). When this continues for very long, a few of the diseases or conditions a doctor may diagnose the individual with include; coronary artery disease, high blood pressure, stroke, irregular heartbeat, backache, tension headaches, rheumatoid arthritis, immunosuppression or deficiency, an autoimmune disease, an inflammatory disease, ulcer, irritable bowel syndrome, diarrhea, nausea and vomiting, ulcerative colitis (inflammation and an ulcer of the colon and rectum), diuresis (kidneys produce to much urine), eczema, neurodermatitis (skin disease), acne, diabetes, amenorrhea (periods stop), fatigue and lethargy, overeating, depression, insomnia, asthma, hay fever, and allergies.

How does fear lead to allergy? When an antigen enters the human body, a macrophage (a scavenger cell that eats bacteria and other foreign objects) picks it up and delivers it to a T cell (type of white blood cell). The T cell simultaneously produces and releases interleukin-1, a protein substance that effects other cells in the immune system, in this case it activates a subset of Helper T cells. These Helper T cells secretes interluekin-2 which stimulates the proliferation of still more T cells. These T cells can either activate or suppress B cells, whose job is to make antibodies. Cortisol, one of the hormones released in response to fear, inhibits the production of both interleukin 1 and 2 and macrophages, thus decreasing the ability of T cells to suppress the B cells from making antibodies to the antigen. In other words, when you are afraid, cortisol is released in large amounts. If fear and anxiety are a normal part of your life, elevated levels of cortisol begin to wreck havoc with your immune system preventing it from properly functioning. T cells diminish in number and those that are present just don’t work as well, allowing the B cells to start attacking every foreign substance that enters the body. When this happens the person develops allergies.

Information for this article was obtained from:
The Bantam Medical Dictionary and Shelby, Jane and McCance, Kathryn L. “Stress and Disease.”
Pathophysiology: The Biologic Basis for Disease in Adults and Children, Third Edition. St. Louis: Mosby, 1998. pp. 286-303.

JH