Since IGF-I stimulates steroidogenesis, the interplay between IGF-I and hyperinsulinism may indicate that early onset androgen excess could be associated with metabolic disturbances later in life.[30] Of relevance to this, Ruder et al. have suggested that intrauterine androgen exposure may be involved in imprinting of the hypothalamus that could possibly influence pubertal onset many years later.[31]. This evidence concerns the gene IGF1 and hyperinsulinism.