Study protocol 1: vascular function in patients without adrenal incidentalomas and patients with NFA
cancer, Cushing’s syndrome, adrenal incidentalomas, Hypertension, hypertensive, nonfunctioning adrenal incidentalomas, hypertension
ADRENAL INCIDENTALOMA, CANCER, RENAL DISEASE, HYPERTENSION, HYPERTENSION, SECONDARY HYPERTENSION
This study was a single-center and prospective cohort study. Between August 2007 and August 2022, a total of 2657 subjects were recruited for vascular function measurements from individuals who attended the outpatient clinic at Hiroshima University Hospital. Of the 2657 subjects, 1105 subjects without computed tomography scans, 790 subjects with secondary hypertension, 399 subjects with cancer, four subjects with severe renal disease, 11 subjects with adrenal incidentalomas who did not receive detailed examinations, and 55 subjects without hypertension and/or DM were excluded. Finally, 22 patients with NFA who had hypertension and/or DM and 272 patients without adrenal incidentalomas who had hypertension and/or DM were enrolled in this study (Supplemental Figure S2).Subclinical Cushing’s syndrome was defined according to the report of the guidelines for diagnostic criteria of adrenal subclinical Cushing’s syndrome: the Japan Endocrine Society 2018. Briefly, the criteria for diagnosis of adrenal subclinical Cushing’s syndrome include the presence of an adrenal mass, lack of characteristic features of Cushing’s syndrome, and normal basal serum cortisol levels. In addition, plasma levels of cortisol after a 1 mg dexamethasone suppression test were used to identify nonfunctioning adrenal incidentalomas (< 1.8 μg/dL), intermediate phenotype adrenal incidentalomas (1.8–5.0 μg/dL), and subclinical Cushing’s syndrome (≥ 5 μg/dL). Hypertension was defined as systolic blood pressure of more than140 mm Hg and/or diastolic blood pressure of more than 90 mm Hg measured in a sitting position on at least three different occasions in the outpatient clinic of Hiroshima University Hospital. Secondary hypertensive patients were excluded from the study as previously reportedSubjects fasted overnight for at least 12 h before the study. The subjects were kept in the supine position in a quiet, dark, air-conditioned room (constant temperature of 22 °C–25 °C) throughout the study. FMD, and NID were measured after maintaining the supine position for thirty minutes. The observers were blinded to the purposes of the study and the clinical status of the subjects. All methods were carried out in accordance with the Declaration of Helsinki, and relevant guidelines and regulations. The Ethics Review Board of Hiroshima University approved the study protocol. All participants in the study provided written informed consent.