INS and obesity due to melanocortin 4 receptor deficiency: According to a meta-analysis describing the impact of obesity on metabolic disturbances in adolescent PCOS, adolescents with obesity and PCOS exhibited significantly reduced levels of SHBG and HDL-C and substantially elevated levels of triglycerides, leptin, fasting insulin, LDL-C, and free testosterone when compared to normal-weight adolescents with PCOS [102].