My son had the same problem of clearing hydrocortisone too quickly in puberty, they just kept increasing the dose which caused weight gain but did not really gain control. He tried dex and pred and hated the way he felt on both and they just added to the weight gain. We changed to Professor Hindmarsh who had already done a paper on the fact that metabolising the cortisol faster can happen in puberty and after many 24 hour profiles and looking at the times where the control was lost, it was decided that he needed the hydro in 6 doses a day. My son then stopped absorbing the cortisol which is where the pump came in. We also thought that he had gone through puberty early but actually it wasn’t proper puberty as such and when the pump brought his levels into perfect control, he started puberty properly. He still clears the cortisol quickly but the pump is set to suit his body’s needs and as the hydrocortisone is delivered continuously, pretty much like a normal person would have it he now has no problems (less side effects such as weight gain). The trick is with any medication, it to have it at the right dose and be given it at the right time. I am a great believer in the circadian rhythm dosing as many people have had such positive results dosing this way as it follows the body’s natural rhythm, we have found this with the pump. Dosing three times a day may help your daughter, smaller doses, more often but this should be tested and approved by the endo. There are of course the longer lasting steroids such as dex and pred but unless you have a physician who is very knowledgeable, like Carol M’s son’s doctor, this can cause weight gain and other side effects.
In saying all this, if your daughter was unwell at the time of her tests, her 17 OHP would have been higher than normal, this is why such tests as androstenedione should be checked too
Not sure if it answers your questions but hope the post helps
The paper I mentioned