I agree with the circadium rhythm recommendation.  My daughter is even on 5 times a day.  Some people just burn up the meds very fast.  So my daughter gets cortef at 3am, 7am, noon, 5pm, and 10pm.  She is getting smaller doses of meds at least every 5 hours.  This really works for her.  It’s as close to the pump as we can get I guess.  You might want to try it before going to an adrenalectomy.  In a perfect world the pump sounds ideal for your daughter.  Unfortunately unless you can travel to the UK it may be unrealistic at this time in the US.   Good luck.  I am so sorry to hear about your daughter.