I sometimes wonder, though, if these researchers pay enough attention to the fact that often cause and effect can be confused. If adrenaline output caused by the same thing that causes the CAH, or is it an affect of the CAH itself? We know that when a hormone isn’t produced, the gland can atrophy or shrink. We also know that adrenaline is produced in response to a perceived threat, so the mind is the immediate cause of adrenaline production. We know that cortisol is the body’s reaction to more prolonged stress, but people with CAH lack that stress response. It seems to me that given the presence of psychological factors in the actual cause of adrenaline production, that that shouldn’t be ignored in concluding that an atrophied adrenal medula is caused by the same gene that causes CAH.

They are arguing for adrenalectomies as a treatment for CAH, without really demonstrating why that would really be necessary. It seems a bit drastic to me.

Could it be that even in smaller children, the lack of prolonged, hormonal stress response shapes subsequent immediate stress response? Wouldn’t the need to deal with the moodiness caused by CAH lead to a different psychological response to perceived stress? Wouldn’t that, then cause an actual physical defference in the part of the body that produces adrenaline?