Other features frequently found in women with PCOS act in synergy with insulin towards enhancing LH release, including hyperleptinemia via AgRP/NPY neural pathways and kiss peptidergic signaling [37], and decreased opioidergic tone, which appears to sensitize pituitary LH-secreting cells to GnRH signaling [38]. Here, PLOD1 is linked to polycystic ovary syndrome.