I always enjoy hearing what others are doing and thinking about dosing, and Dick sounds like he has it well in hand.  There is a one big difference between Addison patients and CAHers, though.  Addisons does not result in an overproduction of androgens, which is the thing that CAH patients fight hardest against.  Waiting until wakening for the first dose of the day (following a very small evening dose) would allow lots of time for androgen breakthrough, as the morning cortisol ramp-up begins well before waking.  Morning blood work under this dosing scheme would almost surely show undersuppression, even though the dosing sounds appropriate for the rest of the day.

Most doctors recommend that the bedtime dose be the second largest so that enough HC is still around to address the early morning ramp-up.  We have addressed this by moving the bedtime dose to 3am, when it is needed.  We can give less total drug this way, reducing the side effects of excess HC at a time when the body doesn't need it.

Laura K