ADIPOQ and obesity due to melanocortin 4 receptor deficiency: Early menarche entails prolonged exposure to estrogens, which promotes fat deposition in peripheral adipose tissue [51,52,53]; in turn, obesity may contribute to elevated blood pressure through multiple mechanisms, including insulin resistance, increased sympathetic activity, aldosterone secretion, sodium and water retention, higher cardiac output, and endothelial dysfunction mediated by adipokines such as leptin and adiponectin [54].