This is paper is co written by Professor Hindmarsh, who developed the pump.  Control in puberty can be difficult and this is when my son’s levels went out of range.  This is why it is so important to try and gain control as of course this is when our children have their growth spurt!  I think there was a time when doctors thought compliance was the problem and now they realise it is not always the case. My understanding is the metabolism can change at this age too, which is exactly what happened with my son.  Tests showed that he was metabolising his hydrocortisone twice as fast as an average person, so he needed doses more often throughout the day.  I would hope that doctors do a 24 hour cortisol and 17 OHP profile to check the metabolism.