INS and obesity due to melanocortin 4 receptor deficiency: Hyperinsulinemia causes increase gonadotrophin releasing hormone (GnRH),reverses LH/FSH ratio such as to 3:1 or 2:1, increases level of androgen and decreases production of sex hormone-binding globulin (SHBG).3 Insulin resistance associated with excessive insulin level can cause metabolic abnormalities which are characteristic feature of this syndrome.4 Obesity, decreased sensitivity of insulin, pre-diabetes, type II diabetes, cardio-metabolic and psychological features such as anxiety, depression etc. are the main metabolic features present in PCOS patients 5,6