Epigenetic processes acquired early or later in life, β-cell size and mass, β-cell insulin receptor expression, differences in metabolic clearance of insulin, differences in the insulin constitutive secretory pathway, differences in central (hypothalamic) regulatory pathways and/or the activity of the parasympathetic nervous system have all been suggested as potential factors involved in the development of hyperinsulinemia [86]. Here, INSR is linked to hyperinsulinism.