When you have CAH, you produce excess androgens when ACTH levels rise. To prevent androgen overproduction, it is necessary to prevent the overproduction of ACTH. Normally, ACTH levels are high during the day and low at night, following a day-night, or "circadian" rhythm. This circadian rhythm is regulated by approximately 24 hour cycles of light and dark. ACTH starts to increase gradually in the early morning hours, around 3 a.m. Around 8 a.m. shortly after you wake, levels reach a sharp peak. After this peak, ACTH then slowly declines, reaching lowest levels during the nightime (From: Hsu, C.Y. and S.A. Rivkees, 2005. Congenital Adrenal Hyperplasia, Authorhouse. Blomington, Indiana.,290pp).

I have read a lot about this topic, asked many times, consulted with the endocrinologists and there is not documented evidence that this method works.  But I have read in this board from many parents that the method works, and that they have seen improvements in growth and in the control of obesity.

I just believe that is not really documented because the schedule is not convenient and probably a high probability of missing a dose. To get up at 3:00 a.m. is a little difficult, but I have done it for 5 days and it is not so bad. She goes right back to sleep....and me too.

On the other hand, the growth hormone has also a circadian rhythm. I have read that when they sleep there is more secretion of the hormone. When glucose levels go down, more GH is secreted. The same as when they do exercised.

If you need more information or some references let me know.