My nephews were born without adrenals and have been on Cortef and Florinef until recently.  The 16 year old started testosterone a couple of years ago and the 15 year old about a year-year and half ago.  They have had their ups and downs but have done quite well.  Recently the 16 year old had a chest congestion and went to M.D.  She gave him decongestants and a blood test.  The blood test showed a ACTH level of 4800.  The younger one had a test of 1000.  The older one was given an MRI of the Pitituary Gland which showed no tumor.  The boys have now been put on prednesone with florinef and testerone 2 times a month.  Has anyone reading this ever had this problem?  The doctors are not sure what to do or what the effects will be.  Of course, they are busy trying to decide what to do next.