Background: Primary aldosteronism (PA), the most common curable salt-dependent form of arterial hypertension, features renal K loss and enhanced Na reabsorption. We investigated whether the electrolyte, water, and TonEBP (tonicity-responsive enhancer binding protein)/ (nuclear factor of activated T cells 5) content is altered in the skin of patients with PA and corrected by surgical cure.
Methods: We obtained skin biopsies from 80 subjects: 49 consecutive patients with PA, optimally treated with a mineralocorticoid receptor antagonist; 6 essential hypertensives; and 25 normotensive controls. We measured Na, K, water content with atomic absorption spectroscopy after ashing, and mRNA with digital droplet polymerase chain reaction. The patients with PA were retested after adrenalectomy.
Results: We discovered a higher dry weight of the skin biopsy specimen at surgery than at follow-up (<0.001) and a direct correlation with electrolyte and water content (all <0.01), indicating the need for dry weight adjustment of electrolyte and water data. Surgical cure of PA markedly increased skin dry weight-adjusted K (from 1.14±0.1 to 2.81±0.27 µg/mg; <0.001) and water content (from 2.92±1.4 to 3.85±0.23 mg/mg; <0.001), but left dry weight-adjusted skin Na content unaffected. In patients with PA at baseline, mRNA was higher (=0.031) than in normotensive controls and decreased after surgery (=0.035).
Conclusions: Despite mineralocorticoid receptor antagonist treatment ensuring normokalemia, the patients with PA had a skin cell K depletion that was corrected by adrenalectomy. The activated /TonEBP pathway during mineralocorticoid receptor antagonist administration suggests enhanced skin Na lymphatic drainage and can explain the lack of overt skin Na accumulation in patients with PA. Its deactivation after surgical cure can account for the lack of skin Na decrease postadrenalectomy.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06090617.
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