Macro‐creatine kinase: a neglected cause of elevated creatine kinase

Abstract

Macro-creatine kinase (macro-CK) is a neglected cause of raised CK. Over a 10-year period, we observed five cases. Three patients had macro-CK type 1. One patient with fibromyalgia underwent several explorations to find a muscular pathology; another, who had elevated CK-MB (muscle-brain fraction) activity, was referred to a cardiologist, and statin therapy was erroneously discontinued in two patients. Two patients had macro-CK type 2: a man with a neuroendocrine carcinoma and a woman with rheumatoid arthritis. Diagnosis of type 1 obviates the need to carry out pointless and expensive investigations seeking a neuromuscular or cardiac pathology, and also, the unwarranted discontinuation of statin therapy. Type 2 must prompt investigations for a neoplasm.

Повышенный Уровень Креатинфосфокиназы У Больных С Отдаленными Последствиями После Перенесенной Закрытой Черепно-Мозговой Травмы

“…In normal value ranges, BB-isoform serum content usually is less than 1 % and during standard diagnostic tests, we could neglect it. However, at different pathological states, serious cell and intra-or extracellular protein damage was detected following cell disturbances with consequent enzyme activity loss [1,3,10,15]. We found high serum CPK-BB levels in the patients with long-term consequences after TBI that may play a certain role in the pathogenetic mechanisms of maintaining these longterm consequences.…”

“…Any change in bioenergy cell homeostasis is one of the important factor determining its pathological disturbances where some key enzymes are adenosine triphosphate (ATP) that provides energy to all biochemical processes and creatine phosphokinase (CPK) that catalyzes reversible reactions of creatine and ATP to phosphocreatine or adenosine diphosphate (ADP) in muscles, brain, retina and hair cells [11,13]. Many conditions cause changes in ATP and CPK serum levels, first of all, heart and central nervous system diseases, kidney disease, rhabdomyolysis, certain medications uptake and others [1,3,10].…”

Evaluation of creatine kinase (CK)-MB to total CK ratio as a diagnostic biomarker for primary tumors and metastasis screening

“…Macro-CK, an atypical CK enzyme complex, can be a neglected cause of falsely increased serum CK-MB activity during routine laboratory assays as it is indistinguishable from normal CK or CK isoenzymes [ 25 ]. Two types of macro-CK have been identified in human serum.…”

Maladies musculaires de l’adulte : quand évoquer le diagnostic ?

“…Au cas où le bilan approfondi reste négatif, avec persistance d'un taux de CK élevé, une électrophorèse des CK pour détec ter un pic de macroCK de type II est recommandée et peut suggérer un processus néoplasique sousjacent. 10…”