LEP and obesity due to melanocortin 4 receptor deficiency: • Obese patients had higher leptin and lower adiponectin levels, which were independently associated with an increased risk of PTS regardless of obesity status.• While inflammation was implicated in PTS development, CRP levels and other inflammatory markers did not differ significantly between PTS and non-PTS groups.• Higher triglyceride levels were noted in patients with PTS, although the difference was modest.