INS and obesity due to melanocortin 4 receptor deficiency: It is reported that hepatic 5α-reductase activity is increased in insulin resistant states [18] and it can be seen from the results that the obese PCOS patients were significantly more insulin resistant than the non-obese PCOS patients and the normal controls (the HOMA-IR did not differ between the non-obese PCOS and normal subjects) suggesting that the increased insulin resistance in obesity may be driving the hepatic 5α-reductase activity converting DHEAS to ADTG.