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examorelin hexarelin l-histidyl-2-methyl-d-tryptophyl-l-alanyl-l-tryptophyl-d-phenylalanyl-l-lysinamide ghsr ghrelin growth hormone secretagogue receptor potent synthetic peptidic orally-active centrally-penetrant secretagogue hexapeptide hormone gh plasma pralmorelin ghrp-2 prolactin adrenocorticotropic acth cortisol insulin-like factor igf-1 factor-binding protein igfbp-1 glucose luteinizing lh follicle-stimulating hormone fsh thyroid-stimulating tsh deficiency congestive heart failure rendering metabolite metabolism biosynthesis cycle mechanism biosynthetic biogenesis substrate precursor synthesis derivative bioprecursor metabolic endogenous