INS and obesity due to melanocortin 4 receptor deficiency: Given that elevations in AAs are associated with obesity and insulin resistance (30) and predict risk of T2D (31), the further reduction in AAs in patients with PBH as compared with unaffected post-surgical patients may reflect the impact of weight loss, altered nutrition, and improved insulin sensitivity to yield an exaggerated “anti-diabetes” metabolic state contributing to reductions in gluconeogenesis.