Pituitary Society Delphi Survey : An international perspective on endocrine management of patients undergoing transsphenoidal surgery for pituitary adenomas

Purpose: In adults and children, transsphenoidal surgery (TSS) represents the cornerstone of management for most large or functioning sellar lesions with the exception of prolactinomas. Endocrine evaluation and management are an essential part of perioperative care. However, the details of endocrine assessment and care are not universally agreed upon. Methods: To build consensus on the endocrine evaluation and management of adults undergoing TSS, a Delphi process was used. Thirty-five statements were developed by the Pituitary Society's Education Committee. Fifty-five pituitary endocrinologists, all members of the Pituitary Society, were invited to participate in two Delphi rounds and rate their extent of agreement with statements pertaining to perioperative endocrine evaluation and management, using a Likert-type scale. Anonymized data on the proportion of panelists' agreeing with each item were summarized. A list of items that achieved consensus, based on predefined criteria, was tabulated. Results: Strong consensus (≥ 80% of panelists rating their agreement as 6-7 on a scale from 1 to 7) was achieved for 68.6% (24/35) items. If less strict agreement criteria were applied (ratings 5-7 on the Likert-type scale), consensus was achieved for 88% (31/35) items. Conclusions: We achieved consensus on a large majority of items pertaining to perioperative endocrine evaluation and management using a Delphi process. This provides an international real-world clinical perspective from an expert group and facilitates a framework for future guideline development. Some of the items for which consensus was not reached, including the assessment of immediate postoperative remission in acromegaly or Cushing's disease, represent areas where further research is needed

Feeding the pyramid builders: Early agriculture at Giza in Egypt

International audienceWhile the exact technical processes employed in the construction of the pyramids are still a subject of ongoing debate, it is widely recognized that the Giza Plateau served as a hub where various trades converged with the common objective of building the necropolis. Of particular importance was the development of a local and sustainable food supply for the thousands of laborers involved in this monumental undertaking. Here, we explore the long-term behavioural mechanisms that led human societies to gradually colonize the Nile swamps at Giza. They developed herding and farming, paving the way for greater human exploitation of the area during the Dynastic Egypt. We show that transhumance tribes, originally from the Eastern Sahara, settled along the Giza Plateau 5200 years ago, primarilyengaging in herding and, more sporadically, agriculture. Giza was transformed into a pastoral landscape, with the development of large swaths of the floodplain, providing societies with permanent access to livestock produce (e.g. proteins, milk, meat and wool). Our palaeoecological data reveal that the initial complex societies at Giza were deeply rooted in transhumance, pastoralism and animal husbandry. These activities played a fundamental role in establishing the foundations of a robust and sustainable food system, while also serving as a crucial logistical support for the subsequent construction of the monumental structures that celebrated the grandeur of pharaonic Egypt