Where does it say that ACTH is produced at midnight?  I just wondered because as far as I was aware ACTH is only released when cortisol levels are TOO low.  Since at midnight cortisol is not needed, I cannot see ACTH being secreted.  I think that these things occur much closer together.   In dosing at 10pm you are giving a high levels of cortisol that is not needed at a time where cortisol is proven to be at it’s lowest in the blood serum.   It is normal to have ACTH secretion, you don’t want to snuff that out completely.  This is what occurs in normal folks in order for cortisol to be released so it is ok.  It is not ok if ACTH is released and shortly after cortisol is not released at the right amount which is dictated by the hypothalmus.  That is where you need to cover which has been proven to be climbing from 3am in studies we have shown.  If any ACTH is released--or a small amount before we dose at 3am, then that will be what would normally be released anyway I would have thought.  It is androgens that cause the problem if we don’t give the hydrocortisone.

At midnight, everything is low and Gh is high as is melatonin.  The body temp is at its lowest.  If you give your dose at 10pm due to the bioavailability, it will peak at approx 11-12 midnight (which means it is highest where it should be at its lowest) and it then falls lower and lower until around 4-6am where it is basically at minimal traves in the blood serum.  ironically this is where it should have been highest.  That is why we say that in dosing conventionally you are dosing back to front on that score.  When you give the cortisol where it is needed and where it would normally be produced, all the other hormones produced adrenally will be far more likely to be produced at their right amounts and right places also as well as other hormones produced by the body such as melatonin and GH.

Cortisol suppresses:

17 OHP,GH and meltonin which need to be released and at their highest when the body is rested and in SWS (slow wave sleep) which takes place from approx two hours after falling asleep.  When we have REM sleep in the later hours of the morning, i.e. 3am onwards, what happens is HPA axis becomes active again.  REM sleep is where you are most like to dream and remmeber the dreams.  So everything slots in just nicely because if your woken at this time you haven’t been robbed of anything and your geting your cortisol surge where it would normally occur. 

Also, if you have each dose adjusted correctly to the right amount where ALL hormones are within normal ranges, then your most likely to get closer to normal growth.  

Also, in dosing as we do, the last dose is 5.30pm.  That dose is 2.50mg.  Not too big to create a problem where GH is concerned, and enough coverage until later at midnight where it should be low anyway.

I don’t think three times a day dosing is too good with circadian dosing.  You need smaller frequent doses atleast 4 times per day.  If you dose three times per day 8 hourly as you say you have to dose at 7am which means dosing the next one at 3pm and no later.  When you do that you don’t give your child a dose then for 12 hours if your next dose falls at 3am.

Cheers

Anne-Marie