SERPINA1 and hyperinsulinemic hypoglycemia, familial, 4: Liver involvement stems from the polymerization of misfolded AAT within hepatocytes, leading to PAS-positive, diastase-resistant inclusions and, over time, hepatocellular injury [9]. While AAT deficiency is relatively common in individuals of European ancestry, it remains underdiagnosed in other populations, including those in India, due to low clinical suspicion and limited access to diagnostic testing [10].