Failed 5 igf-1/acromegaly tests from 2% to 25% over upper normal range. is gh suppression test or dynamic pituitary mri best nest step?

First confirm dx: Before imaging a dx of acromegaly should be confirmed with a growth hormone suppression test. Only after the biochemical diagnosis of the pituitary disease is made should imaging be done. There are other reasons for pituitary abnormalities, including nonfunctional pituitary adenomas. Iit would be a shame to have abnormal imaging and an extensive work up only to find that the dx is not correct!