Hi
Lalantha Perera •,
Welcome to Microsoft Q&A forum and thanks for such detailed question.
As I understand, you are getting huge increase in Storage of Azure SQL Managed Instance.
We are sorry about the inconvenience you are facing.
If not already done, I would suggest you to follow the steps mentioned here for initial level of troubleshooting:
https://learn.microsoft.com/en-us/azure/azure-sql/managed-instance/file-space-manage?view=azuresql-mi to manage files in DB.
OR
https://learn.microsoft.com/en-us/azure/azure-sql/managed-instance/identify-query-performance-issues?view=azuresql-mi to identify query performance bottlwnecks.
OR
https://learn.microsoft.com/en-us/azure/azure-sql/managed-instance/performance-guidance?view=azuresql-mi#best-practices-for-very-large-database-architectures-in-azure-sql-managed-instance consider Best practices for very large database architectures in Azure SQL Managed Instance.
OR
https://learn.microsoft.com/en-us/azure/azure-sql/managed-instance/monitoring-with-dmvs?view=azuresql-mi#identify-high-memory-consuming-statements to identify high memory-consuming statements.
As mentioned by you, there are 24 million records and biweekly alter operation is performed in the DB, this scenario requires deeper investigation of your instance and other details.
Hence, I would recommend you to raise support case and in case if you don't have a support plan, do let us know here so that we can check on other options to unblock you.
Thanks