Hi Martha,

I agree that it is interesting, trying to piece all this stuff together.  The frustrating thing is that there are so many different systems involved in growth....so many different actions, reactions, and feedback loops.  It would be so much easier if everything happened in a nice linear pattern!

I don’t know anything at all about ghrelin.  What gland/organ is it secreted from?  Is it secreted only in response to stress, or also in response to other stimuli?

I guess I don’t see why someone with CAH would necessarily have higher or lower ghrelin  levels than a "normal" person, unless he or she is severely undersuppressed and constantly under physical stress.  In other words, it is not cortisol that triggers the release of ghrelin, but stress that triggers the release of ghrelin...right? 

In someone who does not have CAH, I can see where it might be assumed that someone with high ghrelin levels also has high cortisol levels, if both are secreted in response to stress.  But, in someone with CAH, wouldn’t the levels of cortisol and ghrelin be somewhat independent, since the cortisol is not naturally produced?

See, ask three different people, get three different responses!  

I do have a copy of Dr. New’s article on GH treatment in CAH children, if you’re interested.  It doesn’t really get much into the rationale for why GH might be helpful in children with CAH, as children with CAH aren’t GH deficient.  Her study compares kids who are just on GH and glucocorticoids,  vs. kids who are on GH, Lupron, and glucocorticoids.  If anything, I think many of the kids tend to have advanced, rather than delayed, bone ages.

Let me know if you would like a copy and I’ll be glad to fax or email it to you.

Carol