ADIPOQ and hyperinsulinism: The reasons behind the lower adiponectin levels in patients with MUO are unknown but may be related to the chronic hyperinsulinemia observed in MUO, which suppresses adiponectin production in adipose tissue [29,30], resulting in a positive feedback cycle where decreased adiponectin secretion causes insulin resistance and increased insulin resistance, in turn, causes decreased adiponectin levels [3].