Adipokines such as leptin and proinflammatory cytokines such as TNFα, IL-6 and IL-18 are involved in the pathogenesis of obesity-related insulin resistance in women with PCOS but seem also to be directly implicated in the pathogenesis of ovarian and adrenal dysfunction [56,57,58]. Here, IL6 is linked to obesity due to melanocortin 4 receptor deficiency.