Hi everyone,

I was reading some of the posts on the circadian rythm and the cortisol peaks and dips and some stuff on the internet and just landed up getting thoroughly confused. So here I am again with some more questions. 

1) If I understand right the purpose of the meds is two fold. One to physiologically replace cortisol needed for body functions and second to suppress the HPA axis from producing too much androgens.

2) With conventional dosing it is assumed that the former will automatically take care of the latter, and by conventional I’m thinking every 8 hours, is that right ?

3) I read an article where it says the ACTH secretion due to feedforward mechanism by the pituitary is most active at midnight and therefore the cortisol surge occurs in the early hours.  If the afternoon dose was given at say 2 pm then by midnight I would believe that most of it would be depleted, since the half life of hydrocortisone is about 8 hours.  Therefore, at a time (around midnight ) when the hypothalamus is sensing cortisol drop and therefore the pituitary is secreting ACTH,  it is sending a pretty strong message to the adrenals , in turn too much androgens. I did read that the normal cortisol surge takes place at 4 am or something like that. But isn’t that AFTER the ACTH has done its job . In normal kids this is no problem because their system never actually "runs out" of cortisol. But in our kids don’t we need to dose them before this surge occurs so that when the HPA axis is in gear it senses that there is near-normal cortisol and therefore the ACTH secretion is kept to a near-normal ?

4) Therefore does it not make sense to dose at about 10pm and then a dose eight hours later ?

5) I was having trouble getting my 9 month old to sleep by herself. (She’s spoilt rotten ! ). I was reading this book by Richard Ferber addressing sleep issues. It seems that all our internal clocks run on 25 hour cycle and each day we have to reset the circadian rythm with external clocks for eg, watching the same show every night, having dinner at the same time every night, in essence having a routine everyday. If we didn’t do that then every day our sleep cycle would be extended by an hour simply to cope with this internal clock of 25 hours ! I’m wondering what this might mean to the dosing regimen. Does it mean that regardless of time of dosing, so long as we do it consistently every night, that in itself becomes an individual’s own rythm ?

There are so many of you out there who have all of this down pat. I am still learning so please bear with me if I sound downright stupid. I am hoping as always to learn from the incredible knowledge out there. I would appreciate any comments.

Thanks again,

SueG