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). Here, INS is linked to hyperinsulinism.