Adiponectin, a hormone secreted by adipocytes, plays a critical role in regulating obesity, diabetes, and endothelial dysfunction. It is involved in insulin sensitivity, anti-atherogenic, and anti-inflammatory effects. Adiponectin exists in various molecular forms, with high-molecular weight (HMW) complexes being the most active in metabolic tissues. Adiponectin is produced not only by adipocytes but also by other cells such as skeletal and cardiac myocytes, endothelial cells, and placental tissue. It acts through two receptors, AdipoR1 and AdipoR2, which are structurally distinct from classical G-protein coupled receptors. AdipoR1 is a high-affinity receptor for globular adiponectin, while AdipoR2 is a low-affinity receptor for full-length adiponectin. Adiponectin also interacts with T-cadherin, which is involved in its signaling. Adiponectin signaling involves several pathways, including the AMPK and p38 MAPK pathways, which regulate glucose metabolism, fatty acid oxidation, and insulin sensitivity. Adiponectin enhances glucose uptake in skeletal muscle and improves vascular function by increasing nitric oxide production. It also plays a role in liver function, regulating glucose homeostasis and lipid metabolism. Adiponectin deficiency is associated with obesity, insulin resistance, and cardiovascular disease. Therapeutic strategies to increase adiponectin levels, such as pharmacological agents and exercise, have shown promise in improving metabolic outcomes. However, the use of thiazolidinediones, a class of PPARγ agonists, has been associated with side effects such as edema and liver toxicity. Overall, adiponectin is a promising therapeutic target for the treatment of obesity, diabetes, and cardiovascular diseases.Adiponectin, a hormone secreted by adipocytes, plays a critical role in regulating obesity, diabetes, and endothelial dysfunction. It is involved in insulin sensitivity, anti-atherogenic, and anti-inflammatory effects. Adiponectin exists in various molecular forms, with high-molecular weight (HMW) complexes being the most active in metabolic tissues. Adiponectin is produced not only by adipocytes but also by other cells such as skeletal and cardiac myocytes, endothelial cells, and placental tissue. It acts through two receptors, AdipoR1 and AdipoR2, which are structurally distinct from classical G-protein coupled receptors. AdipoR1 is a high-affinity receptor for globular adiponectin, while AdipoR2 is a low-affinity receptor for full-length adiponectin. Adiponectin also interacts with T-cadherin, which is involved in its signaling. Adiponectin signaling involves several pathways, including the AMPK and p38 MAPK pathways, which regulate glucose metabolism, fatty acid oxidation, and insulin sensitivity. Adiponectin enhances glucose uptake in skeletal muscle and improves vascular function by increasing nitric oxide production. It also plays a role in liver function, regulating glucose homeostasis and lipid metabolism. Adiponectin deficiency is associated with obesity, insulin resistance, and cardiovascular disease. Therapeutic strategies to increase adiponectin levels, such as pharmacological agents and exercise, have shown promise in improving metabolic outcomes. However, the use of thiazolidinediones, a class of PPARγ agonists, has been associated with side effects such as edema and liver toxicity. Overall, adiponectin is a promising therapeutic target for the treatment of obesity, diabetes, and cardiovascular diseases.