Subsequently, elevated free fatty acids (FFAs) enter non-AT including liver, muscle, and pancreas, causing ectopic lipid deposition and associated lipotoxicity that additionally suppresses insulin signaling (54).Mechanistically, hyperinsulinemia promotes HA through three principal pathways: First, insulin directly stimulates the 17α-hydroxylase activity of P450c17 via activation of the PI3K signaling pathway (55), while indirectly enhancing ovarian androgen production by upregulating LH receptor expression (56). This evidence concerns the gene INS and Hyperinsulinemia.