Women with obesity can develop oligomenorrhea, often diagnosed as polycystic ovarian disease, thought to be mediated by central suppression of gonadotrophs (hypothalamic hypogonadism) due to increased aromatase activity by enlarged adipose tissue [26], increased ovarian production of androgenic steroids under the influence of increased insulin levels in subsets of women [27], and/or augmented LH production by elevated leptin levels [28], alone or in combination. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.