SQ-LIP-000012 · v1.10 (archived) · View current version →
Do hormones and heredity influence the onset of lipedema?
Also asked as
- Can hormonal factors and genetics play a role in the development of lipedema?
- Is the onset of lipedema affected by hormones and family inheritance?
- hormones heredity lipedema onset link
- Does having a family history or hormonal changes contribute to getting lipedema?
The evidence consistently links lipedema onset and worsening to female hormonal transitions (puberty, pregnancy, menopause) and to a family history suggesting inherited susceptibility, most likely through tissue-level estrogen signaling and multiple genes rather than one cause. It does not show any difference in blood levels of estrogen or testosterone between patients and healthy women, and no single gene or definitive causal mechanism has been proven.
- Current answer
- Both hormones and heredity appear to influence lipedema onset, but the evidence base remains predominantly low-to-very-low quality (consensus documents…
- Knowledge state
- Probable · Evidence confidence: very low (GRADE) · Stability: Stabilizing
- Evidence
- 27 consistent · 0 conflicting · 3 refining / contextual
- ⚠ none indexed yet — the registry may under-detect disconfirming evidence (a known limitation)
- Evidence verification
- 32/33 sources independently verified · 1 source not retrievable
- Main limitation
- The causal mechanism remains unproven: nearly all supportive evidence is low-to-very-low quality and observational/mechanistic, systemic sex-hormone levels do not differ from…
- Latest change
- This update added two low-quality context articles (an ultrasonography case series and a photobiomodulation study) that mention genetic/hormonal factors and… · v1.10
- Knowledge freshness
- 79% recent · current evidence base
- Last updated
- 2026-07-12 · v1.10
Based on currently indexed evidence, both hormones and heredity appear to influence lipedema onset, but the evidence base remains predominantly low-to-very-low quality (consensus documents, narrative/systematic/scoping reviews, cross-sectional surveys, GWAS, case reports/series), supporting them as contributors rather than proven sole causes. For HORMONAL influence: converging evidence from a 2025 consensus (hormonal trigger/exacerbation rated 4.46), multiple reviews, and cross-sectional surveys consistently reports onset/worsening clustering at female hormonal transitions—puberty (commonly 15.7–72.0%; e.g., 49% perceived trigger in a Saudi cohort, 55% puberty onset in a 67-proband series, mean onset 16±9 yr in a 209-patient survey), pregnancy/lactation (9.5–63.1%; ~53% worsening), and menopause (~1.9–21% onset, ~67–67.9% reporting exacerbation)—alongside near-exclusive female occurrence (~11% of women) and elevated hormone-sensitive comorbidities (PCOS ~12.6–17.1%, menstrual irregularities ~43%, autoimmune thyroiditis up to 35.5%). A low-quality cross-sectional study found 58.8% of hormonal contraceptive users reporting symptom worsening (χ²=213.71, p<0.001; 15.1% reporting onset coinciding with initiation), with acknowledged recall/selection bias. Mechanistic reviews consistently propose tissue-level estrogen dysregulation—an altered ERα/ERβ ratio (reduced ERα, increased ERβ, plus GPER involvement) in gluteofemoral adipose tissue, increased local intracrine estradiol via aromatase (CYP19A1)/17β-HSD enzymes, progesterone resistance, and estrogen effects on ZNF423/PPAR-γ2 in adipose stem cells—reframing lipedema as an estrogen-regulated/estrogen-dependent disorder. A moderate-quality systematic review reinforces four distinct pathophysiological hypotheses (estrogen metabolism/receptor function, growth-hormone imbalance, adipokine/leptin-related adipose stem cell alterations) with possible genetic susceptibility. For HEREDITY: multiple reviews and surveys report frequent positive family history (commonly 15–89% across studies, predominantly female first-degree relatives) with patterns most consistent with autosomal dominant inheritance with incomplete penetrance and sex-limited/female-preferential expression; X-linked dominant inheritance was explicitly excluded by linkage analysis (lod < -2) in the largest studied family. Genetic studies span candidate genes (305 genes via NGS in 162 patients), genome-wide data—a moderate-quality UK Biobank phenotype GWAS identified ~18 loci (SNP heritability ~5.13%) including RSPO3 (OR=1.24), VEGFA, GRB14-COBLL1, ADAMTS9, with genetic correlations to body fat, leptin, and age at menopause; a dedicated moderate-quality UK cohort GWAS (n=130) flagged a suggestive replicated locus near LHFPL6—and family-based sequencing (31 individuals, 9 families) supporting polygenic heterogeneity (variants across 469 genes, no single Mendelian cause). Rare monogenic findings link hormone-metabolism genes—notably AKR1C1/AKR1C enzymes (progesterone/steroid metabolism), with the AKR1C1 c.638T>A (p.L213Q) variant segregating with disease across an autosomal-dominant family (3 affected with puberty onset, absent in 9 unaffected) and predicted to cause partial loss of 20α-HSD function—plus AKR1C2 Ser320PheTer2, regulatory polymorphisms (rs28571848/rs34477787), POU1F1A/PIT1 and NSD1, and syndromic associations (Williams-Beuren/ELN, PXE/ABCC6, cutis laxa/ALDH18A1), offering biological convergence between hereditary and hormonal pathways. IMPORTANTLY, the single highest-quality source—a PRISMA-based systematic review/meta-analysis (DOI 10.1055/a-2183-7414, graded high)—found NO significant difference in circulating testosterone or estradiol between patients and controls, indicating systemic sex-hormone concentrations alone do not explain the condition and pointing instead to tissue-level receptor and metabolic mechanisms; this high-quality finding constrains the hormonal claim to local/tissue-level rather than systemic dysregulation.
A synthesis rendered from the currently indexed evidence — versioned, not a verdict.
⚙ AI consolidation: Claude Opus 4.8 · 2026-07-12 — evidence-bounded; the AI does not opine
This update added two low-quality context articles (an ultrasonography case series and a photobiomodulation study) that mention genetic/hormonal factors and aromatase changes only as background without testing onset causation, reinforcing but not altering the existing answer.
Knowledge freshness = share of the 33 indexed evidence sources from the last 5 years (newest 2026, oldest 2010) . Low freshness flags an ageing evidence base — not that the answer is wrong.
Evidence over time
consistent conflicting refining / contextual Each dot is a study, placed by year and coloured by whether the linked claim supports or contradicts the answer. As the surveillance loop runs, claim revisions and new evidence will extend this timeline. The hollow ring marks the first time this topic appears in the literature.
Answer over time
Each node is a published version of the answer — open one to read the answer exactly as it stood then.
Choose a format (Vancouver default). Citing a version captures the evidence state on that date; this page shows the current version — see version history.
Consistent claims
- SCR-LIP-000004 consistent
Lipedema is a multifactorial disorder whose symptoms are closely linked to female hormonal transitions (puberty, pregnancy, menopause) and to chronic low-grade inflammation, on a polygenic predisposition.
Brazilian Consensus Statement on Lipedema using the Delphi methodology — Amato et al. (2025) · Amato ACM, 2020 - SCR-LIP-000046 consistent
Several findings suggest a hereditary predisposition to lipedema, with frequent family history among affected women.
Brazilian Consensus Statement on Lipedema using the Delphi methodology — Amato et al. (2025) - SCR-LIP-000039 consistent
In women with lipedema, hormonal contraceptive use is associated with self-reported symptom worsening (58.8% of users; 15.1% reporting symptom onset coinciding with contraceptive initiation).
Association Between Hormonal Contraceptive Use and Lipedema: A Cross-Sectional Study With 637 Brazilian Women — Amato et al. (2025) - SCR-LIP-000109 consistent
A systematic review identified four distinct pathophysiological hypotheses linking hormonal dysregulation—particularly estrogen metabolism and receptor function, growth hormone imbalance, and adipokine/leptin-related adipose stem cell alterations—to lipedema development, with possible genetic susceptibility components.
Lower limb lipoedema - male patient — Vargas (2026) · Impact of hormones on lipedema development: a systematic literature review — Lüchinger et al. (2026) - SCR-LIP-000110 consistent
Lipedema is described as an estrogen-regulated polygenic disorder that manifests almost exclusively in women, with onset at hormonal transition phases (puberty, pregnancy, menopause), family aggregation in at least 16% of cases, and a pathological ERα/ERβ receptor pattern in white adipose tissue driving site-specific lipogenesis.
Lipödem – Grundlagen und aktuelle Thesen zum Pathomechanismus — Wiedner et al. (2018) - SCR-LIP-000153 consistent
In a survey of 209 lipedema patients, symptom onset clustered in adolescence (mean age 16±9 years, 32.5% at ages 14-18), family history was common (affected grandmothers 35.4%, mothers 29.7%, aunts 23.0%), and 30.5% of premenopausal patients had sex-hormone imbalances, consistent with hormonal and hereditary contributions to lipedema onset.
New Insights on Lipedema: The Enigmatic Disease of the Peripheral Fat — Bauer et al. (2019) - SCR-LIP-000154 consistent
This critical review proposes an integrative pathomechanism in which lipedema is an estrogen-regulated polygenetic disease, citing up to 60% of cases suggesting autosomal dominant inheritance with incomplete penetrance (Child et al., 330 relatives) and manifestation paralleling feminine hormonal changes, alongside estrogen receptor differences (decreased ERα, increased ERβ in the gluteal region) and animal models (PROX1+/-, VEGFR-3 mutants).
Pathophysiological dilemmas of lipedema — Szél et al. (2014) - SCR-LIP-000141 consistent
In a Saudi cross-sectional study of 115 patients with lower-limb edema, lipedema was clinically confirmed in 71%, affected only women with mean age 38.6 years and mean BMI 30.5, with disease onset typically at ages 20-39, perceived triggers being puberty (49%), pregnancy (22%), and massive weight loss (22%), a positive family history in 46% (predominantly mothers and sisters), and 77% being previously undiagnosed.
Characteristics and Clinical Features of Patients with Lipedema in Saudi Arabia: A Cross-sectional Comprehensive Assessment — Alosaimi et al. (2024) - SCR-LIP-000156 consistent
A case report of idiopathic lipedema in a 62-year-old male—only the third such male case reported worldwide—notes that two of the three known male cases had associated hormonal alterations (alcoholic cirrhosis; type 1 diabetes plus alcohol abuse), and the near-exclusive female predominance is cited as suggesting a hormonal role in pathogenesis.
Lipedema in a male patient: report of a rare case - management and review of the literature — Bertlich M et al. (2021) - SCR-LIP-000157 consistent
This systematic review reports familial incidence of lipedema in 15% of first-degree female relatives consistent with X-linked dominant or autosomal dominant inheritance with incomplete penetrance, identifies an AKR1C1 missense variant (a gene involved in progesterone metabolism) as the first mutated gene in a family with primary non-syndromic lipedema, and notes hormonal/progesterone-pathway involvement.
Lipedema Research—Quo Vadis? — Ernst et al. (2023) - SCR-LIP-000219 consistent
In a series of 67 probands, 14.9% had at least one affected first-degree relative (all affected relatives female), X-chromosome linkage analysis in the largest family excluded X-linked dominant inheritance (lod scores < -2) favoring autosomal dominant inheritance with sex limitation, and onset at puberty in 55% of probands plus near-exclusive female occurrence suggested estrogen-dependent expression.
Lipedema: An inherited condition — Child et al. (2010) - SCR-LIP-000220 consistent
This narrative review reports genetic evidence (305 candidate genes via next-generation sequencing in 162 patients; 18 GWAS risk loci including VEGFA and GRB14-COBLL1 validated in UK Biobank; monogenic AKR1C1 and PIT1 mutations affecting progesterone and growth-hormone/prolactin pathways) supporting both hereditary and hormonal influences on lipedema onset.
Lipedema: Progress, Challenges, and the Road Ahead — Cifarelli (2025) - SCR-LIP-000221 consistent
This integrative review proposes that menopause acts as a critical inflection point in lipedema progression via estrogen receptor imbalance (downregulated ERα and upregulated ERβ in affected tissue), increased local intracrine estradiol production through elevated aromatase (CYP19A1) and 17β-HSD1 with deficient 17β-HSD2, and progesterone resistance, reframing lipedema as an estrogen-dependent disorder.
Menopause as a Critical Turning Point in Lipedema: The Estrogen Receptor Imbalance, Intracrine Estrogen, and Adipose Tissue Dysfunction Model — Pinto da Costa Viana et al. (2025) - SCR-LIP-000222 consistent
This comparative narrative review reports that lipedema is almost exclusively found in women and typically begins during periods of hormonal change (puberty, pregnancy, menopause), and notes heritability/genetic markers as part of its genetics domain.
Current Mechanistic Understandings of Lymphedema and Lipedema: Tales of Fluid, Fat, and Fibrosis — Duhon et al. (2022) - SCR-LIP-000223 consistent
This multidisciplinary review reports that lipedema shows familial history in 30-89% of cases with polygenic GWAS findings (loci in CPE, ZNF25, ZNF33A linked to estrogen biology, plus VEGFA and GRB14-COBLL1, and an AKR1C1 missense variant) and that onset or worsening clusters at hormonal transitions—puberty (15.7-67.3%), pregnancy/lactation (9.5-63.1%), and menopause (1.9-21%)—with estradiol altering ERα/ERβ and PPAR-γ2 expression in lipedema-derived adipose stem cells.
Unraveling lipedema: comprehensive insights and the path to future discoveries — Faria et al. (2025) - SCR-LIP-000224 consistent
In a rigorously defined UK lipedema cohort (n=130), onset was frequently associated with hormonal changes (puberty, pregnancy, menopause), and the first dedicated GWAS identified a suggestive genetic locus (rs1409440, OR_meta 2.01, P_meta 4×10⁻⁶) upstream of LHFPL6, replicated in an independent 100,000 Genomes cohort.
Investigation of clinical characteristics and genome associations in the ‘UK Lipoedema’ cohort — Grigoriadis et al. (2022) · Investigation of clinical characteristics and genome associations in the ‘UK Lipoedema’ cohort — Grigoriadis et al. (2021) - SCR-LIP-000225 consistent
This review proposes that dysregulated estrogen signaling in adipose tissue—via an increased ERα/ERβ ratio in gluteofemoral adipocytes or excessive local paracrine estrogen production by adipocyte steroidogenic enzymes—drives the excessive subcutaneous fat accumulation in lipedema, and cites whole-exome sequencing linking lipedema to variants in sex hormone genes, with onset coinciding with hormonal fluctuation periods such as puberty, pregnancy, and menopause.
Lipedema and the Potential Role of Estrogen in Excessive Adipose Tissue Accumulation — Katzer et al. (2021) - SCR-LIP-000226 consistent
A GWAS of an inferred lipedema phenotype in UK Biobank women identified 18 genome-wide significant loci (SNP heritability ~5.13%), including RSPO3 (OR=1.24), GRB14-COBLL1, VEGFA, and ADAMTS9 (some replicated in an independent clinically-diagnosed lipedema cohort), with genetic correlations to body fat, leptin levels, and age at menopause.
Genome-wide association study of a lipedema phenotype among women in the UK Biobank identifies multiple genetic risk factors — Klimentidis et al. (2023) - SCR-LIP-000215 consistent
Family-based exome sequencing of 31 individuals from 9 lipedema families identified candidate variants in 469 genes with no single gene shared across all families, supporting genetic heterogeneity rather than a Mendelian single-gene cause, with gene ontology enrichment in vasopressin receptor activity (AVPR1A, AVPR2), microfibril binding (FBN, ELN, LTBP), and patched binding (PTCH1/2, Hedgehog pathway).
A Family-Based Study of Inherited Genetic Risk in Lipedema — Morgan et al. (2024) - SCR-LIP-000238 consistent
This systematic review reports that lipedema most likely follows autosomal dominant inheritance with incomplete penetrance and sex limitation (positive family history in up to 64% of women), identifies no confirmed gene for primary non-syndromic lipedema, and catalogs syndromic associations (POU1F1A c.196C>T p.Pro24Leu; NSD1 p.Cys2175Ser/Sotos; 7q11.23 deletion/Williams-Beuren with ELN, FZD9, MLXIPL; ABCC6/PXE; ALDH18A1/cutis laxa III) plus 17 GWAS/animal-model candidate genes (e.g., LYPLAL1, TBX15, HOXC13, RSPO3, VEGFA, PROX1, VEGFR3, PRDM16).
Genetics of lipedema: new perspectives on genetic research and molecular diagnoses — Paolacci S et al. (2019) - SCR-LIP-000229 consistent
This narrative review reports that lipedema onset is associated with periods of hormonal fluctuation (puberty, pregnancy, menopause) and describes estrogen-dependent mechanisms (increased aromatase CYP19A1, estrogen-induced ZNF423 hyperproliferation), alongside a proposed female-preferential autosomal dominant inheritance pattern.
Lipedema: Insights into Morphology, Pathophysiology, and Challenges — Poojari et al. (2022) - SCR-LIP-000230 consistent
This review reports that lipedema develops or worsens during hormonal-change windows (puberty, pregnancy, menopause, oral contraceptives), with ~20% of cases identified at menopause and ~67% of patients reporting symptom exacerbation at its onset, and proposes an estrogen-receptor imbalance (decreased ERalpha/increased ERbeta) in affected adipose tissue as a central mechanism.
Lipedema: From Women’s Hormonal Changes to Nutritional Intervention — Tomada (2025) - SCR-LIP-000231 consistent
This review proposes AKR1C enzymes (AKR1C1-4) as a central biological pathway linking rare familial mutations (e.g., AKR1C1 L213Q segregating with lipedema across 3 generations, AKR1C2 Ser320PheTer2) and common regulatory polymorphisms (rs28571848, rs34477787) to lipedema through altered steroid hormone metabolism in gluteofemoral subcutaneous adipose tissue, with environmental endocrine disruptors and hormones converging on the same hereditary pathway.
From rare familial mutations to multifactorial disease: aldo-keto reductase 1C enzymes as a central biological pathway in lipedema — Vainberg et al. (2026) - SCR-LIP-000232 consistent
This review synthesizes evidence that estrogen and its receptors (ERα, ERβ, GPER) influence lipedema pathogenesis, noting disease onset/aggravation during hormonal-fluctuation windows (puberty, pregnancy, menopause) and that altered ER expression in gluteofemoral subcutaneous adipose tissue (reduced ERα, increased ERβ) parallels the regional fat accumulation characteristic of lipedema, affecting ~11% of women.
Estrogen as a Contributing Factor to the Development of Lipedema — Al-Ghadban et al. (2021) - SCR-LIP-000313 consistent
A scoping review of 25 studies reports that lipedema symptom onset clusters at reproductive hormonal milestones (puberty/adolescence in 62.2-72.0% of cohorts, worsening in pregnancy in 53.0% and menopausal transition in 67.9%), with elevated hormone-sensitive comorbidities (PCOS 12.6-17.1%, autoimmune thyroiditis up to 35.5%) and molecular findings including loss-of-function variants in AKR1C1/AKR1C2, aromatase (CYP19A1) upregulation in adipose tissue, and altered estrogen receptor balance.
Lipedema in Women and Its Interrelationship with Endometriosis and Other Gynecologic Diseases: A Scoping Review — Viana et al. (2025) - SCR-LIP-000314 consistent
This narrative review proposes that lipedema involves a common genetic alteration—an imbalance of estradiol receptors (ERα > ERβ) in adipose tissue present in all cases—combined with physiological hormonal fluctuations (puberty, pregnancy, menopause), endocrine disruptors, and estrogen-dependent gynecological disorders, citing associations such as menstrual irregularities (43%) and PCOS (17%) in women with lipedema.
Hormonal Links between Lipedema and Gynecological Disorders: Therapeutic Roles of Gestrinone and Drospirenone — Viana & Câmara (2025) - SCR-LIP-000315 consistent
Whole-exome sequencing in a family with autosomal dominant nonsyndromic primary lipedema identified the AKR1C1 c.638T>A (p.L213Q) variant segregating perfectly with the disease in 3 affected members (puberty onset in all) and absent in 9 unaffected members, with molecular dynamics and QSAR predicting partial loss of 20α-HSD function that may promote lipogenesis via reduced progesterone catabolism.
Aldo-Keto Reductase 1C1 (AKR1C1) as the First Mutated Gene in a Family with Nonsyndromic Primary Lipedema — Michelini et al. (2020)
Conflicting claims
- None indexed yet.
Refining / contextual
- SCR-LIP-000111 context
A systematic review of lipedema pathology found that testosterone and estradiol showed no significant difference versus controls in plasma analysis, while the condition almost exclusively affects females and its fundamental etiology remains largely uncertain despite growing molecular and histological research.
Auf der Suche nach der Evidenz: Eine systematische Übersichtsarbeit zur Pathologie des Lipödems — Funke et al. (2023) - SCR-LIP-000406 context
In a retrospective analysis of ultrasonographic images from 34 women clinically diagnosed with lipedema, the article states the etiology remains uncertain but may be related to genetic and female hormonal factors, without testing this relationship.
J. Biomedical Science and Engineering, (2025) - SCR-LIP-000407 context
In a study of PBMT applied before dermolipectomy in three lipedema patients, the article notes that lipedema predominantly affects women during hormonal phases (menarche, pregnancy, menopause) and reports laser-induced upregulation of aromatase (CYP1A1), a hemoprotein involved in hormone metabolism, without directly testing hormonal or hereditary causes of onset.
Lasers in Medical Science (2025) 40:437 (2025)
Major uncertainty
The causal mechanism remains unproven: nearly all supportive evidence is low-to-very-low quality and observational/mechanistic, systemic sex-hormone levels do not differ from controls (high-quality finding), and no single confirmed gene or Mendelian cause exists for primary non-syndromic lipedema—so whether hormones and heredity are true causal drivers versus correlated modifiers of a polygenic, tissue-level estrogen-signaling process is not established.
Version history
- SQ-LIP-000012 · v1.10 — 2026-07-12 — This update added two low-quality context articles (an ultrasonography case series and a photobiomodulation study) that mention genetic/hormonal factors and aromatase changes only as background without testing onset causation, reinforcing but not altering the existing answer. · view this version
- SQ-LIP-000012 · v1.9 — 2026-06-02 — Answer recompiled after human curation of the claim set. · view this version
- SQ-LIP-000012 · v1.8 — 2026-06-02 — Answer recompiled after human curation of the claim set. · view this version
- SQ-LIP-000012 · v1.7 — 2026-06-02 — Answer recompiled after human curation of the claim set. · view this version
- SQ-LIP-000012 · v1.6 — 2026-05-31 — This update added four supporting low/very-low-quality sources—a scoping review of 25 studies and a narrative review quantifying hormonal-milestone onset and hormone-sensitive comorbidities, a 130-patient UK GWAS linking loci to hormone biosynthesis/lipid hydroxylation, and a whole-exome study showing the AKR1C1 p.L213Q variant segregating perfectly across an autosomal-dominant family—reinforcing the existing hormonal and hereditary evidence without altering the overall direction or the high-quality finding of no systemic sex-hormone difference. · view this version
- SQ-LIP-000012 · v1.5 — 2026-05-31 — Answer recompiled after human curation of the claim set. · view this version
- SQ-LIP-000012 · v1.4 — 2026-05-31 — Answer recompiled after human curation of the claim set. · view this version
- SQ-LIP-000012 · v1.3 — 2026-05-31 — This update added a substantial body of genetic evidence (multiple GWAS including UK Biobank loci such as RSPO3/VEGFA/ADAMTS9 and a dedicated cohort locus near LHFPL6, family-based sequencing supporting polygenic heterogeneity, linkage analysis excluding X-linked dominant inheritance, and additional AKR1C/POU1F1A hormone-pathway findings) plus several mechanistic reviews reinforcing tissue-level estrogen-receptor imbalance and menopause as an inflection point, strengthening but not changing the prior affirmative, evidence-bounded answer. · view this version
- SQ-LIP-000012 · v1.2 — 2026-05-31 — This update added six supporting items—survey and cross-sectional data on adolescent onset timing and high familial prevalence, two reviews proposing estrogen-regulated polygenic mechanisms with specific candidate genes (AKR1C1 progesterone-metabolism variant, familial Pit1 mutation) and inheritance patterns up to 60%, and a rare male case report invoking a hormonal hypothesis—strengthening the breadth of evidence for hormonal and hereditary influence without altering the prior cautious conclusion. · view this version
- SQ-LIP-000012 · v1.1 — 2026-05-31 — This update added a 2026 systematic review formalizing four hormonal pathophysiological hypotheses, a 2018 mechanistic review characterizing lipedema as an estrogen-regulated polygenic disorder with quantified family aggregation and ERα/ERβ receptor data, and a 2023 PRISMA-based systematic review providing the important counterpoint that circulating estradiol and testosterone levels are not significantly elevated versus controls—collectively deepening the mechanistic framing while introducing a key null finding on systemic hormone levels. · view this version
- SQ-LIP-000012 · v1.0 — 2026-05-30 — founding index (30 claims) · view this version
Key references
DOI:10.1590/1677-5449.202301832 · DOI:10.7759/cureus.99189 · DOI:10.53347/rid-217362 · DOI:10.1007/s00404-026-08318-1 · DOI:10.1055/a-0767-6842 · DOI:10.1055/a-2183-7414 · DOI:10.1097/prs.0000000000006280 · DOI:10.1016/j.mehy.2014.08.011 · DOI:10.1097/gox.0000000000006173 · DOI:10.3205/iprs000161 · DOI:10.3390/jpm13010098 · DOI:10.1002/ajmg.a.33313 · DOI:10.1111/obr.13953 · DOI:10.3390/ijms26157074 · DOI:10.3390/ijms23126621 · DOI:10.1038/s44324-025-00093-y · DOI:10.1371/journal.pone.0274867 · DOI:10.1101/2021.06.15.21258988 · DOI:10.3390/ijms222111720 · DOI:10.1038/s41431-022-01231-6 · DOI:10.1089/lrb.2023.0065 · DOI:10.26355/eurrev_201907_18292 · DOI:10.3390/biomedicines10123081 · DOI:10.3390/endocrines6020024 · DOI:10.4081/vl.2026.15495 · DOI:10.5772/intechopen.96402 · DOI:10.20944/preprints202512.2108.v1 · DOI:10.9734/jammr/2025/v37i25731 · DOI:10.3390/ijms21176264 · DOI:10.4236/jbise.2025.184008