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Annals of the New York Academy of Sciences , 1033 , 3041

These drugs engage multiple hormonal pathways simultaneously, and researchers are still working to untangle which mechanisms are driving which effects

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As shown in Table 1 [1,8,12-19] , because of the critical role of this pathway in energy regulation, functional abnormalities caused by mutations in any of its critical genes (e.g., LEP , LEPR , POMC , PCSK1 , MC4R ) can lead to severe early-onset obesity and extreme hyperphagia and are often accompanied by endocrine abnormalities due to deficiencies in related hormones, such as hypogonadism and hypothyroidism [12,20]

The pathophysiology is thought to involve increased sensitivity to cholecystokinin (CCK), leading to excessive gallbladder contractility