OGTT is not always needed. In the presence of clinical features of acromegaly, a frankly elevated IGF-1, and a pituitary adenoma visible by MRI glucose suppression test is not necessary.

I typically initiate the screening for acromegaly by checking the IGF-1 level in patients with dx pituitary adenoma or clinical suspicious of acromegaly. In addition, I include baseline GH level assessment as part of the initial evaluation. In cases where serum IGF-1 levels are mildly elevated or eq...