Pathophysiologic Mechanisms of Insulin Secretion and Signaling-Related Genes in Etiology of Polycystic Ovary Syndrome

Figure 2

Mechanisms of direct and indirect effects of hyperinsulinemia on hyperandrogenemia. Insulin via increasing the sensitivity of theca cells to LH and adrenal cortex to ACTH elevated the synthesis of androgens in these tissues. Also, insulin via direct effect on the liver and by suppression of production of SHBG and IGF1BP leads to the increased serum level of androgens and eventually hyperandrogenemia.