Two receptors, not one
Compounds described as growth hormone secretagogues fall into two mechanistically unrelated groups. GHRH analogs — sermorelin, tesamorelin, CJC-1295 — act at the GHRH receptor on somatotrophs and amplify the amplitude of endogenous secretory pulses. Ghrelin mimetics — ipamorelin, GHRP-2, GHRP-6, hexarelin — act at the growth hormone secretagogue receptor GHS-R1a and both stimulate release and suppress somatostatin tone.
Because the two act at different receptors on the same cell, their effects in preclinical models are more than additive, which is the entire rationale for the combination preparations that pair a GHRH analog with a ghrelin mimetic.