AQP4 and hyperinsulinemic hypoglycemia, familial, 4: This mechanism aligns with preclinical studies showing estrogen deficiency downregulates aquaporin-4, a key protein for perivascular fluid transport (Zhang et al., 2024; Kato et al., 2024), and clinical data linking ALPS indices to cognitive decline in aging (Kamagata et al., 2022; Taoka et al., 2017).