The Occurrence of Type 2 Diabetes (T2D) in Adolescent Females

The occurrence of type 2 diabetes (T2D) in adolescent females can lead to the development of polycystic ovarian syndrome (PCOS) . PCOS is the result of follicular atresis and ovulatory dysfunction brought about by a hyper-androgenic microenvironment in the ovary. Which of the following statements reflects the underlying cause of the hyperandrogenic state in females with T2D?

A) hyperinsulinemia, associated with T2D, reduces the level of sex hormone-binding globulin leading to increased free testosterone.
B) T2D in adolescents is primarily the result of obesity and the associated disruption in fatty acid metabolism negatively affects adrenal estrogen production.
C) the increased level of circulating lipid in T2D patients competes for steroid binding to sex hormone-binding globulin resulting in a reduced transport of estrogen within the ovary.
D) the persistent hyperglycemia associated with T2D causes increased levels of glycosylated hemoglobin, which interferes with the need for increased ovarian vascularization at puberty