Increased circulating levels of pro-inflammatory mediators, including highly sensitive C-reactive protein (hsCRP), tumour necrosis factor (TNF)-alpha, procalcitonin and interleukin-18 (IL-18), have been reported in women with PCOS (33, 34), and although more pronounced in the context of obesity, these associations persist even after correction for total fat mass. This evidence concerns the gene TNF and obesity due to melanocortin 4 receptor deficiency.