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Free hCG- has been shown to function synergistically with progesterone to stimulate the differentiation of cultured human endometrial cells to decidualized cells80 and to be a potent stimulator of decidual prolactin secretion in vitro.81 Given the proximity of the trophoblast to the decidua and the substantial levels of free subunit produced, it is reasonable to propose that free hCG- could play a key role in controlling decidual formation and prolactin release in vivo

Many patients have both conditions at the same time, making diagnosis tricky

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The proposed mechanism most often cited involves GIP-receptor-mediated effects on adipose insulin sensitivity and possibly on central energy balance, though attribution between the two receptors in vivo remains an area of ongoing study

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