Hormonal Rhythm Disturbance Is a Potential Contributor to Postoperative Cognitive Dysfunction of Pituitary Tumor Surgery.

Abstract

Background: Postoperative cognitive dysfunction (POCD) is a common disorder following surgery. The mechanisms underlying this are still under exploration. We hypothesize that hormonal changes in patients who have undergone pituitary surgery contribute to the pathogenesis of POCD.

Methods: In a 12-month follow-up study, a total of 103 patients with pituitary adenoma who received pituitary surgery were included. Patients were categorized into three groups based on their postoperative hormonal supplement: stable, sufficient, and insufficient to eliminate the effects of surgery and hormone dosage. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were employed as evaluation tools to assess the degree of cognitive impairment.

Results: The MoCA score in the stable group showed no significant decrease, while in the sufficient and insufficient groups, the score began to decrease from the 6th month compared to the 0 month of each group. Compared to the stable group at the same time point, the MoCA scores in both groups decreased at the 6th month and 12th month. A similar trend was observed in the MMSE score. Cognitive impairment (mild cognitive impairment and dementia) in both the sufficient group and the insufficient group increased significantly by the 3rd month after surgery, but the rate of increase was much slower subsequently in the sufficient group than in the insufficient group.

Conclusion: Our study confirms that POCD is highly prevalent in patients after pituitary tumor surgery. Postoperative hormone deficiency plays a crucial role in the progression of POCD, especially adrenocorticotropic hormone and the glucocorticoids it affects. It is worth mentioning that a novel aspect of our study is the identification of hormonal rhythm disturbance as a potential contributor to POCD, which provides valuable insights into the mechanisms of POCD in pituitary surgery. We call for more personalized and chronobiological hormone replacement therapy approaches.