Supplementary Material for: Hormonal rhythm disturbance is a potential contributor to postoperative cognitive dysfunction of pituitary tumor surgery

Background: Postoperative cognitive dysfunction (POCD) is a common disorder following surgery. The mechanisms underlying are still under exploration. We hypothesize that hormonal changes in patients 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 and 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 stable group showed no significant decrease, while in sufficient and insufficient groups, the score began to decrease from the 6th month compared to 0 month of each group. Compared to the stable group at the same time point, the MoCA scores in both groups decreased at 6th month and 12th month. A similar trend was observed on MMSE score. Cognitive impairment (MCI and dementia) in both sufficient group and insufficient group increased significantly by the 3rd month after surgery, but the rate of increase was much slower subsequently in sufficient group than in 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 ACTH and the glucocorticoids it affects. It is worth mentioning that, a novel aspect of our study is the identification of hormonal rhythms disturbance as a potential contributor to POCD, which provide valuable insights into the mechanisms of POCD in pituitary surgery. We call for more personalized and chronobiological hormone replacement therapy approaches.