In an extensive review of clinical data, Pillai and Littlejohn [31] identified a trend in comorbidity of DISH, obesity, and adult onset (type 2) diabetes mellitus with disturbance in metabolism of growth hormone and related hormones, insulin and related hormones, and adipokines (i.e. cytokines secreted by adipose tissue). This evidence concerns the gene GH1 and diffuse idiopathic skeletal hyperostosis.