I see a lot of discussions about weight gain and have a 4y/o f with swcah.  She has been gaining more and more weight despite good levels and growth.  she is well over the 100th % for weight and in the 90th for height.  her good height confused me because you would think that she wouldn’t be growing as well if she was oversupressed.  I tried typical dietary and excercise solutions without success.  I also have other non CAH children who are thin.  Anyway I read about circadian rhythem dosing and spoke with my endocrinologist and now have a new plan.  I would like anyone’s opinion on this.  She was on hydrocortisone 5mg @ 8am, 2.5mg @ 2-3pm, 5mg @ 1030-11pm.  hydrocortisone starts to kick in in about 1hr, and lasts about six, therefore her 1030 dose was gone just as her 17ohp was peaking around 4am.  To me this was a completely wasted dose.  She was oversupressed between 1130pm-4am and undersupressed from 0430 until 9am.  So we changed her to 3am 3.75mg, 8am 3.75mg, 3pm 1.25mg, 8-9pm 1.25mg.  This way the doses later in the day are just minor replacement but we are really hitting the early morning and morning peaks while decreasing the total dose.  What do you think?