I think there are so many hormones that affect growth and metabolism. As you know, they just discovered ghrelin, I’m sure they’ll discover many more.

When I read your first paragraph - about ghrelin going up with stress - I was thinking that the body would interpret oversuppression as stress and raise the ghrelin levels. So too much hydrocortisone (cortisol) would signal that the body is under "stress" and raise the ghrelin levels. Wouldn’t oversuppression = excess stress hormone (cortisol) = extra ghrelin? This would be consistent with oversuppression/too much steroid and ghrelin both causing excess appetite while undersuppression with its low stress hormones could cause the body to produce less ghreline?

As far as the growth and bone age, I think it gets so complicated with the many hormones, I’m not sure how you sort out which hormones’ affect dominates. I remembering reading something a couple of years ago about growth hormone being secreted at night. The article mentioned off-hand that GH was secreted in the largest amounts when cortisol secretion was at its lowest (middle of the night). I wonder if the cortisol levels or the ghreline levels have a stronger affect on GH?

Maybe you can have low GH secretion even if when you have high suppression, high cortisol, high ghrelin due to the timing of the GH secretion. Even if ghrelin wants to increase GH secretion maybe it can’t because the cortisol never goes low enough?? Kids with too low of cortisol levels (undersuppressed) get the double bone age advance whammy because their androgens are high and their cortisol is low enough to allow too much GH at night??

I also wonder how weight affects bone age. My son has been pretty oversuppressed for much of his life, yet his bone age is not delayed, it is right on. His endo has mentioned that excess weight can lead to early puberty and advancing bone age. I kind of think that my son’s bone age gets delayed due to oversuppression, but then gets advanced due to weight and we end up splitting the difference with matching chronological age. It would be great if they could sort out to hormones well enough to give us a good picture of what controls what. I can only imagine how much better treatment would be if we could understand the interconnectedness of it all.

Your lab work must be fascinating. I often think that in another life (or at least when this one slows down) I would love to go into medical research.

Thanks for your post. I would love to hear more.