Hi Laura,

Sorry for the late reply (and thanks for the offer of the extra room...may in fact take you up on it, when I’m feeling in need of a break from the same ol’, same ol’!)

Re. your questions:

1. Yes, florinef can, in fact, affect the dose of hydrocortisone that is needed. If the florinef dose is too low, blood volume can be reduced, which may trigger a stress response. This will make levels higher and the CAH harder to control.

2. Hmmm...I am sorry I don’t have anything earth shattering to add, but, from what you’ve said, it does sound like maybe dehydration is part of the problem. This might sound obvious, but rather than changing florinef doses, have you tried increasing her liquid intake? Have you also tried cranberry juice, which is the old standby for making urine less acidic?

I’m sorry your daughter has to go through all this...I wish I had better suggestions for you.