Ok, let’s see if I can do this without rambling too much! :o)

My son Connor, who is 6 (53 lbs 47.5’’) and has SWCAH, has always been what the endo has called nicely suppressed on a fairly low dose of Cortef.  Until the latest bloodwork, he has been on 7.5mgs of Cortef and .05mgs Florinef and we have been doing the circadian dosing schedule as follows:  2.5mgs at 7am and florinef, 1.25mgs at 12pm, 2.5mgs at 5:30pm, and 1.25mgs at 3am.  His latest result are as follows:  Testosterone: 11ng/dL, Plasma Renin Activity 76 ng/dL/h, 17 OHP 87 ng/dL, and Androstenedione 73ng/dL.  The endo is concerned about the elevated levels of Testosterone and Andros.  In the past Testosterone has always been <3.0 ng/dL and Andros have been <10ng/dL.  In light of this, he wants to increase the Cortef to 2.5mgs 4 times daily.  Should we do this in the equal doses he suggests, or should we be giving a larger dose, say at 3am to mimic the "normal" surge of cortisol?  By increasing the overall dose are we going to super suppress the 17OHP?  Also, since it is evident that his Testosterone is elevated, can this help explain his sometimes really aggressive behavior?  Thanks for the help!!

Dana