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Creatine Kinase (CK): Unexpectedly High²

• Asymptomatic high CK: General
  • More common in males than females
  • May occur at all ages
  • If high CK persists after rest: Evaluation usually includes
    • EMG
    • Muscle biopsy
• Causes of high CK with few or no symptoms
  • Endocrine
    • Hypothyroid
    • Hypoparathyroid
  • Exercise: Acute & Producing Muscle Hypertrophy
  • Muscle Trauma: Injections (esp phenothiazines); Psychosis; Falls
    • An EMG virtually never elevates a normal CK to abnormal levels
  • Myopathies (asymptomatic)
    • Dystrophy
      • Dystrophinopathy
      • Limb-Girdle MD (LGMD): 1C; 2A; 2B
    • Metabolic
      • Glycogen Storage Disorders
      • CPT2 deficiency
      • AMPDA deficiency
    • Other hereditary myopathy
      • Central core
      • Danon
      • Distal
      • Malignant Hyperthermia
      • Mitochondrial disease
      • Myofibrillar myopathy
      • Myopathy with tubular aggregates
      • Myotonia: Congenita; DM2
    • Acquired disorders
      • Inflammatory
      • Drug toxicity
  • Denervation: Motor neuron diseases, but not polyneuropathies, often produce high CK.
• Idiopathic
  • Hereditary Idiopathic
  • Other Idiopathic: 50% to 80% of HyperCKemia
    • Normal muscle: 30%
    • Non-specific muscle abnormalities: 30%

Creatine Kinase (CK): Low¹

• Muscle disease
  • Reduced mass: End-stage disease
  • Corticosteroid treatment
  • Myosin-loss: Especially weeks after onset
  • Dermatomyositis, childhood type: Some patients
• Hyperthyroidism
• Multiorgan failure
• Rheumatic diseases: Active inflammation
  • Rheumatoid arthritis
  • Systemic lupus erythematosis
  • Spondyloarthropathies
  • Fasciitis
  • Perimysiitis