SHBG and obesity due to melanocortin 4 receptor deficiency: It has been demonstrated that the underlying cause of PCOS in adolescents with obesity actually lies in hyperinsulinemia, which, as mentioned earlier is able to promote androgen production in the ovaries and adrenal glands as well as decrease the hepatic synthesis of sex hormone-binding globulin (SHBG), thus leading to an excessive amount of androgens [68].