I keep thinking with ghrelin that there’s gotta be a negative feedback loop somewhere- it’s just a question of where. From an evolutionary standpoint, it makes since if you’re stressed you should increase your energy intake (thus the increase in appetite and increase in food intake) But if you’re too stressed, you wouldn’t want to put that energy towards growth. Also evolutionary speaking, it seems that if someone wasn’t stressed, that would be a prime time for growing and something other than ghrelin would trigger GH secretion. You’re probably right, they’ll discover another hormone any day now that will be the link between cortisol, ghrelin, and GH. But I want to know now!
The excess weight gain that can lead to early puberty is because of a hormone called leptin. In fact, leptin is the antagonist of ghrelin! Leptin is produced by fat cells within the body and signals postive energy balance. Of course the more fat you have, the more leptin you produce, so the less circulating ghrelin. In addition to helping to regulate metabolism, leptin is a trigger for puberty. The theory is you need a certain amount of fat (or I guess ’energy in reserve’ might be a better way to think of it) to trigger puberty. Sure enough, when leptin is injected into prepubertal mice, the mice reach puberty much earlier than the control mice. I have no idea how leptin affects bone age- it’s an interesting idea, I’ll have to see if there is any literature out there!
Hmmm... I wonder if the oversupression initially causes too much ghrelin production. Then these oversupressed kids gain tons of weight, thereby increasing leptin production which would then decrease the ghrelin levels. Since ghrelin goes down, GH would decrease, and so would bone age? Maybe that’s how we can get around the ghrelin lvls not being high in oversuppressed kids- it’s because of the leptin!
I feel very fortunant to work in a place where I can perhaps discover something that will make life better for people with CAH. I must admit, I was kinda lackluster about the whole research thing until my daughter came along. It was just happenstance that the work we do is somewhat related to CAH. Haha, and don’t think I do medical research. I’m actually in a poultry science department trying to make life better for a bunch of chickens! However, much of the work we do can be applied to a human system.
Thanks for writing- you’ve helped me link a few things together!!!

MarthaF