Some questions (and answers), which you can pose to your Doctor next time Jill:

Question: Do the adrenal glands make aldosterone every other day, every day?

Answer:  The adrenal glands make aldosterone every day.

Question: Does the amount of aldosterone the adrenal glands make vary?

Answer: The amount of aldosterone varies during different times of the day.

Question:  When we dose Florinef (aldosterone equivalent) is the Biological half life?

Answer:   Good One!  I would like to know the answer to this one.  Can you ask him/her?

Question :  What happens if my child is sick on a day when we are not meant to dose Florinef????

Answer:  Well I’d like them to answer that also... because apparently when under stress and ACTH levels are raised, the body requires more aldosterone.  So on a day when your child is sick, and not dosed Florinef--this could be a problem.

Florinef or Floudrocortisone is twice as potent as the hormone aldosterone, but aldosterone is made continuously by the adrenal glands and the objective of dosing the Florinef is that it gives coverage as obviously with SWCAH a child cannot make it. 

I think the point of dosing replacement is to try to get as close to what the adrenals would do.  I firmly believe that dosing in the way you suggest (once a day but halving the tablets) is far better than nothing on one day and something on the next.  Better and safer for the child. 

The aldosterone production would vary from one day to the next, but in no way would it not produce "nothing" on every other day. 

Hope that that helps...and if you can ask those questions, that would be great.  ;)

regards

Anne-Marie