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Figure 3: Hypothalamic-pituitary-ovarian axis and the role of insulin in PCOS. [19] The increased frequency of hypothalamic gonadotropin-releasing hormone (GnRH) pulses leads to increased frequency of luteinizing hormone (LH) pulses, which ultimately result in increased production of androgens by the ovary theca cells. Insulin acts synergistically with LH to enhance androgen production. (scc - side chain cleavage enzyme, StAR - steroidogenic acute regulatory protein and 3-HSD - 3-hydroxysteroid dehydrogenase. Solid arrows denote a higher degree of stimulation than dashed arrows)

Figure 3: Hypothalamic-pituitary-ovarian axis and the role of insulin in PCOS. [19] The increased frequency of hypothalamic gonadotropin-releasing hormone (GnRH) pulses leads to increased frequency of luteinizing hormone (LH) pulses, which ultimately result in increased production of androgens by the ovary theca cells. Insulin acts synergistically with LH to enhance androgen production. (scc - side chain cleavage enzyme, StAR - steroidogenic acute regulatory protein and 3-HSD - 3-hydroxysteroid dehydrogenase. Solid arrows denote a higher degree of stimulation than dashed arrows)