SHBG and obesity due to melanocortin 4 receptor deficiency: Although disordered insulin action is independent of obesity in PCOS, increased body mass index (BMI) exacerbates insulin resistance, leading to excessive androgen production by the liver and adrenal cortex as well as decreased hepatocyte sex-hormone binding globulin (SHBG) production and metabolic dysfunction in peripheral tissues, such as skeletal muscle and adipose tissue [5,10].