INS and hyperinsulinism: The mechanisms responsible for hypertension in women with PCOS may be explained as follows: first, insulin resistance could cause secondary hyperinsulinemia, which may produce enhanced sodium retention and play a role in the development of hypertension (23, 24); second, insulin could stimulate the release of insulin-like growth factor (IGF-1), which may determine the vascular smooth muscle hypertrophy and thus contribute to the hypertension (25); third, hyperandrogenemia also seems to be related to blood pressure (15).