CK Unexpectedly High

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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
High CK with few, no, or atypical symptoms: Causes
- Endocrine
  - Hypothyroid
  - Hypoparathyroid
- Exercise ⁴
  - Acute
  - Producing Muscle Hypertrophy
- Muscle Trauma: Injections (esp phenothiazines); Psychosis; Falls
  - CK time course after injury
    - Onset of rise: < 12 hours
    - Peak values: 1 to 3 days
    - Decline: 3 to 5 days
    - Half life: 36 to 48 hours
    - Failure to decrease: Ongoing muscle injury
  - EMG
    - Rarely elevates a normal CK to abnormal levels
    - Peak CK: 1x to 1.5x baseline in 6 hours
    - Return to baseline: 48 hours
- Myopathies (asymptomatic)
  - Dystrophy
    - Dystrophinopathy
    - Limb-Girdle MD (LGMD): 1C; 2A; 2B; 2P
  - Metabolic
  - Other hereditary myopathy
  - Acquired disorders
    - Inflammatory
    - Drug toxicity
- Denervation ⁵
  - Motor neuron diseases
  - Small fiber polyneuropathies
  - Not: Sensory-Motor polyneuropathies
- Newborns ³
  - May be high with vaginal delivery or C-section
  - Range: 265 to 3100
Idiopathic
- Hereditary Idiopathic
- Other Idiopathic: 50% to 80% of HyperCKemia
  - Normal muscle: 30%
  - Non-specific muscle abnormalities: 30%