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Diagnostic criteria of acromegaly have significantly changed over the last 25 years, providing different cut-offs of serum GH levels both in basal conditions and after glucose inhibition. Historically, due to several analytical limitations in GH and insulin-like growth factor I (IGF-I) assays, the confirmation of clinically suspected acromegaly was primarily based on dynamic tests involving the administration of substances known to acutely and physiologically modulate GH secretion. In some cases, paradoxical GH responses have been observed during these dynamic tests. The oral glucose tolerance test (OGTT), performed with the administration of 75 g of glucose, is currently the only dynamic test recommended by clinical guidelines in acromegaly. Initially, a paradoxical response during OGTT was defined as the failure of GH suppression following glucose exposure. More recently, this definition has evolved with the introduction of additional criteria, including the percentage increase in GH levels, the GH ratio, and temporal parameters. Over time, the GH response during OGTT has been used for different purposes. Initially, it served as a diagnostic tool; however, the most recent consensus statements recognize its role as a prognostic indicator of long-term remission following neurosurgical treatment. Therefore, considering the predictive value of certain dynamic tests in assessing treatment response in acromegaly, this review aims to provide a comprehensive overview of the evolution of dynamic testing in acromegaly, with a specific focus on tests associated with paradoxical GH responses.<\/jats:p>","DOI":"10.1007\/s11102-026-01649-x","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T08:37:21Z","timestamp":1774946241000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["To test or not to test: what we have learnt from 50 years of dynamic testing in acromegaly"],"prefix":"10.1007","volume":"29","author":[{"given":"Laura","family":"De Marinis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Chiloiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Mancini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penelope","family":"Giamb\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Giampietro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Bianchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Pontecorvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Giustina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"issue":"19","key":"1649_CR1","doi-asserted-by":"publisher","first-page":"1926","DOI":"10.1056\/NEJMra2409076","volume":"393","author":"A Giustina","year":"2025","unstructured":"Giustina A, Colao A, Acromegaly (2025) N Engl J Med 393(19):1926\u20131939","journal-title":"N Engl J Med"},{"issue":"9","key":"1649_CR2","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1007\/BF03349263","volume":"31","author":"A Giustina","year":"2008","unstructured":"Giustina A, Barkan A, Chanson P et al (2008) Guidelines for the treatment of growth hormone excess and growth hormone deficiency in adults. 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Gius. have served as investigators for clinical trials funded by Novartis, Pfizer, Ipsen and Crinetics. SC and AB received grants from Pfizer. SC won the 2022 Arrigo Recordati Research Grant. And. Gius. participated in Advisory Board meetings for Alexion, Amolyt and Crinetics pharmaceuticals and has occasionally consulted for Ipsen, Pfizer and Recordati and received research grant to the University from Recordati. And. Gius. is Editor in Chief of Pituitary. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"67"}}