Primary hyperaldosteronism induces congruent alterations of sodium homeostasis in different skeletal muscles: a 23Na-MRI study

Abstract

Background: Sodium homeostasis is disrupted in many cardiovascular diseases, which makes non-invasive sodium storage assessment desirable. In this regard, sodium MRI has shown its potential to reveal differences in sodium content between healthy and diseased tissues as well as treatment-related changes of sodium content. When different tissues are affected disparately, simultaneous assessment of these compartments is expected to provide better information about sodium distribution, reduce examination time, and improve clinical efficiency. Objectives: 1) to investigate sodium storage of calf and pectoral muscle in health, disease, and quantify changes following medical treatment; 2) to demonstrate homogenous disruption in skeletal muscle sodium storage in patients with primary hyperaldosteronism (PHA). Methods: We assessed sodium storage levels (relative sodium signal intensity, rSSI) in the calf and pectoral muscles of 8 patients with primary hyperaldosteronism prior and after treatment, and 12 age- and sex-matched healthy volunteers. Results: Calf and pectoral muscle compartments exhibited similar sodium content both in healthy subjects (calf vs pectoral rSSI: 0.14±0.01 vs. 0.14±0.03) and PHA patients (calf vs pectoral rSSI: 0.19±0.03 vs 0.18±0.03). Further, we observed similar treatment related changes in pectoral and calf muscles in the patients (proportional rSSI change calf: 26%; pectoral: 28%). Conclusion: We found that sodium was distributed uniformly and behaved equally in different skeletal muscles in Conn's syndrome. This allows to measure both heart and skeletal muscle sodium signals simultaneously by a single measurement without repositioning the patient. This increases 23Na-MRI's clinical feasibility as an innovative technique to monitor sodium storage.

Low sodium intake ameliorates hypertension and left ventricular hypertrophy in mice with primary aldosteronism

“…These results consolidate the notion that cardiac function deterioration induced by excessive aldosterone is largely dependent on salt status. Recently, Christa et al found that PA patients showed treatment-reversible significantly higher tissue sodium signals in the myocardium, calf muscle, and skin compared to healthy controls ( Christa et al, 2019 ; Christa et al, 2022 ). This is a novel explanation for the relationship between sodium and LV hypertrophy in PA. BNP is a neurohormone that is activated by volume expansion and pressure overload of cardiac ventricles ( Epshteyn et al, 2003 ), In the present study, our results show that TASK −/− mice exhibit obvious sodium retention and a rise in BNP and β-MHC mRNA levels in LV tissue.…”

Non-invasive assessment of tissue sodium content in patients with primary adrenal insufficiency

“…Previous studies mainly led by Titze’s group have shown that tissue sodium reservoir expands and contracts depending on the salt intake ( 9 ). Increased muscle and skin sodium concentrations have furthermore been observed in patients with refractory hypertension, primary aldosteronism, heart failure and insulin resistance ( 11 , 12 , 14 , 15 , 17 ), most of which are associated with increased activity of GC and MC ( 18 , 19 , 20 ).…”

“…Since 23 Na is a nucleus with a fast multi-exponential signal decay a relevant part of the signal could not be detected with the sequence used due to the echo time of 2.01 ms. Consequently, we do not report absolute values of tissue sodium but the relative sodium signal intensity (rSSI) which is the 23 Na signal intensity of the calf muscle relative to a reference vial containing an aqueous solution with a concentration of 100 mmol/L that was scanned with every participant. This concentration was chosen to avoid bias during calibration, as it provided a signal-to-noise ratio high enough for calibration (11,15) while even higher concentrations might have induced image artifacts outside the vial.…”

“…Non-invasive assessment of tissue sodium has been made possible by sodium MRI ( 23 Na-MRI). Increased muscle and skin sodium concentrations have been associated with refractory hypertension, primary aldosteronism, heart failure and even insulin resistance, suggesting that tissue sodium overload might be an independent cardiovascular risk factor ( 11 , 12 , 13 , 14 , 15 ).…”

Effects of natural products on skin inflammation caused by abnormal hormones secreted by the adrenal gland

“…The hormones secreted by adrenal gland play an important role in the metabolism ( Sevilla et al, 2013 ), regulation of blood pressure ( Reincke et al, 2021 ), and homeostasis of sodium or glucose ( Kuo et al, 2015 ; Christa et al, 2022 ). Natural products may influence secretion of hormones from adrenal gland.…”