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The mechanism of action is due to the fact that Larazotide acts as an antagonist against zonulin, which is a protein in the small intestine that affects gut permeability

97 YangY.WangZ.ZhangL.YinB.LvL.HeJ.et al (2018)
Daily rhythm: Ever heard of the circadian rhythm
For brand-name pens with room-temperature windows (Ozempic, Mounjaro), a single overnight at room temperature below 86 degrees Fahrenheit is generally safe and counts against the product room-temperature allowance

World J Diabetes 2015

While many clinicians (and laboratories) still refer to this as testing the adrenals, it is much more accurate to say that such testing is assessing the status of the HPA axis using adrenal hormone measurements as surrogate markers
