Hi Carol,

If your Daughter had been gaining weight, then I would say it is due to the dosing.  30mg per day seems quite high and the bodies needs for cortisol vary from one part of the day to the next but your daughters dosing schedule looks very primitive.  For example she would certainly not need as much hydrocortisone  in the afternoon as she has in the morning.  We don’t dose the evening dose, we dose at 2am but that is besides the point.  Things are not as rigid as giving a child your daughters age 10mg on every dose.  They have refined the dosing regimes from the one she appears to be on at present.  before we changed, my son (aged 10) SWCAH (dxd at birth) was only on 5mg am, 2.50mg afternoon, and 7mg evening.  Now I relaise that there are different severities of CAH and your daughter may have more severe type...but somehow I don’t think her body demands for cortisol vary from the way the body would normally make cortisol. 

She would get side effects anywhere where she was overdosed within a 24 hour period.  That means if she was only supposed to be on 5mg in the afternoon, she would get side effects with the other 5mg she takes.  This would NOT be picked up on a blood tests taken at 8am because by that time the overdosed amount would have been excreted. 

I have mentioned that the best way to determine what a childs doses of cortisol should be on each dose is the 24 hour profiling.  this is bloods taken every 4 hours like they did when they fine tuned her levels at diagnosis. 

Excess steroids cause weight gain.  It is not your daughters metabolisn causing excess weight gain I suspect, but the way she is dosed her meds.  Hope that this helps. :)

Anne-Marie