CYP19A1 and obesity due to melanocortin 4 receptor deficiency: Consequently, the hyperinsulinemia that occurs in girls experiencing obesity is considered to play a facilitating role in early puberty by leading to stimulation of adrenal and ovarian androgen production, decreased hepatic synthesis of sex hormone-binding globulin (SHBG), and increased aromatase activity in adipocytes [80,83,84].