# Thoracic Back Pain Leading to an Acromegaly Diagnosis: A Case Report

## TL;DR

A patient with long-term thoracic back pain and signs of acromegaly was found to have a pituitary tumor, highlighting a possible link between DISH and acromegaly.

## Contribution

This is the first reported case linking DISH findings to acromegaly, suggesting a need for increased vigilance for acromegaly in DISH patients.

## Key findings

- A patient with chronic thoracic back pain and acromegaly features was found to have a GH-secreting pituitary macroadenoma.
- SPECT CT identified increased metabolic activity in the anterior column suggestive of DISH.
- This case suggests DISH may be a sign of underlying acromegaly.

## Abstract

Diffuse idiopathic skeletal hyperostosis (DISH), a common cause of thoracic backache, may be caused by unregulated growth factor activity by increasing enthesis and bony growth. Excess growth factors can cause acromegaly. We describe the case of a patient presenting with chronic thoracic axial back pain for several decades and features of acromegaly on history and physical exam. Single photon emission computed tomography (SPECT) CT was obtained to identify the pain generator and detected increased metabolic activity in the anterior column suggestive of DISH. Subsequent laboratory testing revealed acromegaly. Follow-up imaging identified a growth hormone (GH)-secreting pituitary macroadenoma with local invasion. To the best of our knowledge, this is the first time the finding of DISH has hinted at the possibility of acromegaly, and may illustrate the need for added vigilance for acromegaly in patients with DISH.