INS and Cushing syndrome due to macronodular adrenal hyperplasia: This includes mutations in the glucokinase and hepatocyte nuclear factors 1 and 4 genes, genetic abnormalities that inhibit the conversion of proinsulin to insulin, endocrinopathies like Cushing’s syndrome and glucagonoma which antagonizes insulin action and excessive damage to the pancreas caused by conditions such as pancreatitis, pancreatic carcinoma and pancreatic fibrosis [136].