I’m reading the second post in by Bonnie and feeling the need to correct her by saying that any excess hormone can bring on early puberty be it produced from the adrenal glands OR the gonads in a CAH child.  Thats because the excess hormone from adrenal gland is the same as the hormone produced from the gonads, and also because at a certain level it switches on production from the gonads and once that occurs it is not something that can be corrected or reversed.  CAH children produce male hormone from the adrenal glands in such large amounts that it can practically exceed the "normal" amount produced by the gonads in a normal child and on top of that they can produce many times more than is needed at that given time when under suppressed.  

It makes no difference where the excess hormone is coming from at the end of the day as the male hormone  released from adrenal glands into the blood, body tissues etc has exactly the same effect on the body and such tissues as the type produced from the gonads.   I wish it wern’t the case but it’s true unfortunately.  Though it would not normally exceed certain miniscule amounts from adrenals, one has to realise that the adrenals are simply not functioning the same as they would normally and infact are capable of producing infinate amounts of male hormone or androgens despite the sex of the child and inspite of it.  It’s one of the primary reasons why girls are masculinised at birth and why they develop differently to girls who don’t have CAH in other ways.  It’s one of the reasons why these children are difficult to control through puberty or why it is difficult to deipher whether puberty is occuring at a normal age for that child or whether that child is undersuppressed and hitting puberty too early.  Well it is difficult in such cases where the child has a family history of puberty occuring early anyway and when it occurs at ages such as 10 or 11 yrs old etc.    This can be slowed down or overcome by careful monitoring and raising  doseages of medication but sometimes the side effects of such are not very pleasant.  Growth restriction again being one of those as I’m sure most folks know here. Girls need a certain amount of testosterone but obviously not the same amount that a pubertal boy has floating around!

I think the poster of the thread requested to know if circadian rythym dosing would help.  It is my opinion that it would to some degree as long as you can be compliant with the dose and this becomes more difficult at 3am or such time than it does giving med’s during the day really.  It all depends upon your compliancy with the schedule.  Obviously if your less compliant with circadian dosing, then things can take a turn for the worse not better.  Especially if the child is not under good control to begin with.  I’d tend to get the hormone levels as they should be before embarking on a dose time change then you have a fresh slate and can see if it is the ideal dosing pattern for your child.  I mean if you have a child whose hormones are out of control and embark on circadian dosing, and things dont improve, there has been a delay getting the hormones in control.  Also bloods come back differently anyway because you have essentially switched the last dose, so it can be deceiving as a dose at 3am would effect a different blood result to one given at something like 9-10pm? 

If the height is coming in at taller than average and the bone age is in advance of the chronological age, then it may be best to look at dose adjustments up if such symptoms are evident, than assume they are not early signs that puberty could b on the horizon in my opinion also.