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re: re: ...I also meant to say Mar. 26th, 2007 2:46pm
One other thing that is odd about the high cortisol results my daughter got: if the prednisone was still exerting an effect, wouldn't her cortisol level have been suppressed
Kat as I understand it and from the experience with my son, and what his endo has explained to me, is that cortisol cannot be measured accurately in the blood whilst taking pred (or dex) The cortisol from the pred shows a lower reading than it is actually giving, I think only up to 75% unlike hydrocortisone which is synthetic cortisol so that would be 100%' However the amount of cortisol you need to suppress the adrenals for CAH, depends on the way the cortisol suppresses the 17 OHP level. For example, when my son's adrenals were enlarged, he needed a much higher reading of cortisol to suppress the 17 OHP, so he was on a high dose. As the adrenals shrunk back, he needed less hydro (cortisol) to suppress the 17 OHP. In CAH cortisol measured on its own, is not much use, you need to look at the 17 OHP level along side this. My son has had many 24 hour profiles measuring both cortisol and 17 OHP to fine tune his medication. A person without CAH or adrenal problems make varying amounts of cortisol at various parts of the day (circadian rhythm) and of course when stressed, the cortisol levels rise. It could be that your daughter does make a reasonable amount of cortisol, but not enough to suppress the androgens. So in commenting on your statement above, I would say that the prednisone wouldn't be suppressing her cortisol levels, it only may be suppressing the adrenals, so she would need less cortisol. People with Addison's who take dex or pred as a replacement do not have high androgens, so there replacement values are tested on their ACTH levels. I have often wondered if this is why children with LOCAH manage without having crisis's as they have enough cortisol to keep them alive and fairly healthy, even enough to rise in stress but not enough stop the androgens, which eventually causes the early puberty. This is my two cents worth and hope it helps. I have found this very interesting and look forward to seeing what the out come of the new tests.
