Hi Kathy,

They give some of the kids here in NZ a combination of hydrocortisone and prednisone.  The pred is being given at night since they learned the potency of hydrocortisone is not covering through the night.  I cringed when I read that actually because they talk now about HCT being growth toxic, so I was concerned about Pred at night after I learned that.  I fancy it’s qualities at the top of the day though as an AM dose which would cut the necessity for an afternoon dose.  However, that’s only because of the way we dose at the moment.  I had wondered about pred at 3am and hydrocortisone at say 5pm.  I Kind of wondered if that combination would be good given that we give the largest dose at 3am now and that it would perhaps peak nicely be high enough around 7am.  Then low in the afternoon.  You could just have a top up at 5.30pm of say 3mg Hydrocortisone.  Well thats how I would dose with the circadian rythms anyway.  I am not sure about it last thing at night and even Addisons patients find that they do not get good sleep when taking Pred late at night from what I read. 

I thibnk the key thing is giving Chris enough of a more potent cortisol early in the morning when he needs it most to cover him through the day.  Even a 6am dose of it would be good and then Hydrocortisone at night perhaps?