In this alternative framework, hyperinsulinemia could be caused by intrinsic defects in β-cells or insulin clearance mechanisms, or it may be a response to environmental conditions (such as pre- or post-natal exposure to hyperandrogenemia, inflammation or overnutrition) that stimulate increased β-cell mass, elevated insulin secretion, or reduced insulin degradation. The gene discussed is INS; the disease is polycystic ovary syndrome.