GHRL and Abnormal emotional state: We propose that psychological distress and associated eating disorders during these periods lead to the epigenetic (Figure 3) dysregulation of (neuro)hormones (e.g., AMH, androgens, estradiol, insulin and ghrelin) involved in the pubertal upregulation of the HPG axis, which contributes to the development of PCOS and related comorbidities in these subjects (Figure 2B).