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Engels I, Weingartz M, Kornblum C, Grigull L. [Powerless muscles in McArdle disease - what general practitioners should know]. MMW Fortschr Med 2024; 166:10-12. [PMID: 38376673 DOI: 10.1007/s15006-024-3588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
- Isabelle Engels
- Zentrum für Seltene Erkrankungen, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Monika Weingartz
- Glykogenose Deutschland e. V., Am Römerberg 33e, 55270, Essenheim, Deutschland
| | - Cornelia Kornblum
- Klinik und Poliklinik für -Neurologie, Sektion Neuromuskuläre Erkrankungen, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Lorenz Grigull
- Zentrum für Seltene Erkrankungen, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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2
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Slipsager A, Andersen LK, Voermans NC, Lucia A, Karazi W, Santalla A, Vissing J, Løkken N. Fatigue and associated factors in 172 patients with McArdle disease: An international web-based survey. Neuromuscul Disord 2024; 34:19-26. [PMID: 38042739 DOI: 10.1016/j.nmd.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/04/2023]
Abstract
McArdle disease is an autosomal recessive inherited disease caused by pathogenic variants in the PYGM gene, resulting in virtual absence of the myophosphorylase enzyme in skeletal muscle. Patients experience physical activity intolerance, muscle pain, and muscle fatigue. This study aimed to investigate other fatigue domains with the Multidimensional Fatigue Inventory (MFI-20) along with an investigation of potential contributing factors, including relevant disease and lifestyle-related factors. We conducted a survey in an international cohort of patients with McArdle disease. The survey included questions on demographics and McArdle disease-related symptoms, and the questionnaires: MFI-20, Insomnia Severity Index (ISI), and International Physical Activity Questionnaire Short-Form (IPAQ-SF). One hundred seventy-four responses were included in the data analyses. We found relatively high fatigue scores in all five domains (general fatigue (12.9 ± 2.2), mental fatigue (10.1 ± 4.1), physical fatigue (13.7 ± 4.1), reduced activity (12.1 ± 4.1), and reduced motivation (10.4 ± 3.4)). Fatigue associated with McArdle symptom severity (p < 0.005), lower levels of physical activity (assessed by IPAQ-SF) (p < 0.05), and poor sleep (assessed by ISI) (p < 0.05). These findings call for clinical focus and future research into fatigue, sleep and mental health in patients with McArdle disease.
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Affiliation(s)
- Anna Slipsager
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linda Kahr Andersen
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nicol Cornelia Voermans
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Alejandro Lucia
- Physical Activity Health Research Group (PaHerg), Research Institute of Hospital 12 de Octubre ('i+12'). Madrid, Spain; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Walaa Karazi
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands
| | | | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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3
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Kalsoom H, Mukhtar H, Latif RK. Exercise induced muscle weakness in a young adult: McArdle's disease unusual presentation. J PAK MED ASSOC 2023; 73:2473-2475. [PMID: 38083936 DOI: 10.47391/jpma.8401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
McArdle's disease (Glycogen storage disease type V) is a rare inherited autosomal recessive disease involving defect in enzyme, glycogen phosphorylase (PYGM) which results in accumulation of glycogen mainly affecting skeletal muscles. It commonly presents in childhood and rarely in adults with symptoms like exercise intolerance, muscle weakness, cramps and fatigue. Herein, we report an unusual case of a 22 years old male in Pakistan with probable McArdle's Disease presenting with repeated episodes of generalized cramping muscle pain, exercise intolerance and haematuria. The diagnostic approach to identifying this disease as well as the differentials of other rare types of skeletal muscle disorders that should be kept in mind while dealing with a similar clinical picture, irrespective of the age of presentation, have been discussed.
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Affiliation(s)
- Hira Kalsoom
- Combined Military Hospital, Lahore Medical College, Lahore, Pakistan
| | - Haseeb Mukhtar
- Combined Military Hospital, Lahore Medical College, Lahore, Pakistan
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Famili DT, Fernandez-Garcia MA, Vanegas M, Goldberg MF, Voermans N, Quinlivan R, Jungbluth H. Recurrent atraumatic compartment syndrome as a manifestation of genetic neuromuscular disease. Neuromuscul Disord 2023; 33:866-872. [PMID: 37919205 DOI: 10.1016/j.nmd.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
Compartment syndrome (CS) is a medical emergency that occurs secondary to excessively high pressures within a confined fibro-osseous space, resulting in reduced perfusion and subsequent tissue injury. CS can be divided into acute forms, most commonly due to trauma and considered an orthopaedic emergency, and chronic forms, most commonly presenting in athletes with recurrent exercise-induced pain. Downstream pathophysiological mechanisms are complex but do share commonalities with mechanisms implicated in genetic neuromuscular disorders. Here we present 3 patients with recurrent CS in the context of a RYR1-related disorder (n = 1) and PYGM-related McArdle disease (n = 2), two of whom presented many years before the diagnosis of an underlying neuromuscular disorder was suspected. We also summarize the literature on previously published cases with CS in the context of a genetically confirmed neuromuscular disorder and outline how the calcium signalling alterations in RYR1-related disorders and the metabolic abnormalities in McArdle disease may feed into CS-causative mechanisms. These findings expand the phenotypical spectrum of RYR1-related disorders and McArdle disease; whilst most forms of recurrent CS will be sporadic, above and other genetic backgrounds ought to be considered in particular in patients where other suggestive clinical features are present.
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Affiliation(s)
- Dennis T Famili
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Miguel A Fernandez-Garcia
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Maria Vanegas
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Nicol Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, United Kingdom.
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5
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McCann UG, Park T. Rhabdomyolysis in McArdle disease caused by scuba diving. BMJ Case Rep 2023; 16:e255192. [PMID: 37852664 PMCID: PMC10603480 DOI: 10.1136/bcr-2023-255192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
McArdle disease is a glycogen storage disease that results in rhabdomyolysis during intense exercise. A number of different triggers have been described. We evaluated a patient with McArdle disease who presented with rhabdomyolysis after recreational scuba diving. There was no concern for barotrauma or decompression sickness. His symptoms resolved with standard-of-care management for non-diving-related rhabdomyolysis. Features of his experience provoked questions about the diving-related factors contributing to his presentation. We present the case and explore possible mechanisms of diving-related injury in patients with McArdle disease, including the possible effects of hyperoxia, hyperbaria, hypothermia and strenuous activity.
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Affiliation(s)
- Ulysse George McCann
- Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Thomas Park
- Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Jiang WZ, Xu YW, Wang YW, Zhu XC, Gong YY, Zhou HW, Fu ZZ. Diagnosis and genetic analysis of a case with glycogen storage disease type V caused by compound heterozygous mutations in the PYGM gene. Yi Chuan 2022; 44:1063-1071. [PMID: 36384998 DOI: 10.16288/j.yczz.22-223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Glycogen storage disease type V is an autosomal recessive genetic disorder caused by muscle glycogen phosphorylase (PYGM) deficiency, which is characterized by exercise intolerance, second wind phenomena and high level of serum creatine kinase. In this study, we reported a Chinese young man with glycogen storage disease type V, with lower extremity weakness after exercise, increased creatine kinase, and slight fat infiltration in the posterior group of thigh muscle by magnetic resonance imaging (MRI). The proband had complex heterozygous PYGM disease-causing mutations, including c.308T>C (p.L103P) variant transmitted from the mother and c.260_261delCT (p.S87Ffs*23) from the father, of which the former was a novel PYGM mutation. This study enriched the PYGM pathogenic gene mutation spectrum, contributed to improve clinicians' understanding of glycogen storage disease type V and provided a reference for further genetic study of the disease.
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Affiliation(s)
- Wan-Zi Jiang
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yi-Wen Xu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yi-Wen Wang
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiao-Cheng Zhu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ying-Yun Gong
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hong-Wen Zhou
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhen-Zhen Fu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Vidal-Sanahuja R, Ortez-González CI, Nascimento-Osorio A, Colomer-Oferil J. [McArdle's disease in four pediatric patients. Diagnostic algorithm for exercise intolerance]. Rev Neurol 2022; 75:129-136. [PMID: 36098446 DOI: 10.33588/rn.7506.2022212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION McArdle's disease is caused by a mutation in the PYGM gene, causing a muscle myophosphorylase deficiency, altering the release of glucose-1-P from glycogen. It usually manifests itself in childhood with early and excessive tiredness, myalgias, cramps and contractures or rhabdomyolysis, although it is not usually diagnosed until adulthood. Creatine kinase increases sharply during exercise. Four pediatric patients are presented, the pathophysiology is summarized, and a diagnostic algorithm is proposed. PATIENTS AND METHODS Ages between 6 and 14 years, the anamnesis, physical examination, biochemistry, elec-tro-myogram, ischemia test and genetic study are described. Muscle biopsy in a single patient. The algorithm was developed from the ischemia test. RESULTS In the three men, myalgias appeared after finishing each sports session. Phenomenon 'second wind' in one case. Ischemia test without lactate elevation and marked ammonia elevation in all. Only one muscle biopsy with glycogen deposits and absence of myophosphorylase. PYGM gene with homozygous mutations in all. Dietary treatment attenuated their symptoms during aerobic exercises. CONCLUSIONS The ischemia test was very useful to demonstrate a dysfunction in anaerobic glycolysis. It is worth noting that oral glucose supplementation is very useful in McArdle disease, but is contraindicated in all six defects of anaerobic glycolysis. The algorithm also allows targeting the defect of 20 metabolic or structural myopathies, which are summarized.
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Iacono S, Lupica A, Di Stefano V, Borgione E, Brighina F. A novel compound heterozygous mutation in PYGM gene associated with McArdle's disease. Acta Myol 2022; 41:37-40. [PMID: 35465342 PMCID: PMC9004334 DOI: 10.36185/2532-1900-067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
McArdle's disease is an autosomal recessive glycogenosis due to mutation in the myophosphorylase gene (PYGM) resulting in a pure myopathy. The clinical onset typically occurs in childhood with cramps, myalgia, and intolerance to physical exercise, although late onset forms are also reported. We describe a case of a 17-year-old male complaining of cramps and myalgia following brief and intense exercise. The patient reported marked improvement in muscle fatigability few minutes after starting aerobic exercise. When he was a child, he had experienced few episodes of vomiting, nausea, and black colored urine following physical activity. Laboratory testings revealed high creatine kinase serum levels. Genetic testings for metabolic myopathies demonstrated a compound heterozygous for two PYGM mutations (p.R570Q and p.K754Nfs*49) allowing the diagnosis of McArdle's disease. To date, 183 mutations in the PYGM gene are listed in Human Gene Mutation Database Professional 2021.2, but this novel compound heterozygosis has never been reported before.
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Affiliation(s)
- Salvatore Iacono
- Section of Neurology, Department of Biomedicine, Neuroscience, and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Antonino Lupica
- Section of Neurology, Department of Biomedicine, Neuroscience, and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Vincenzo Di Stefano
- Section of Neurology, Department of Biomedicine, Neuroscience, and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Eugenia Borgione
- Unit of Neuromuscular Diseases, Oasi Research Institute-IRCCS, Troina, Italy
| | - Filippo Brighina
- Section of Neurology, Department of Biomedicine, Neuroscience, and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
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Gooch C, Dean SJ, Marzullo L. Repeatedly in Rhabdomyolysis. Pediatr Emerg Care 2021; 37:e1759-e1760. [PMID: 32205805 DOI: 10.1097/pec.0000000000002079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Repeated presentations of a rare symptom in a patient should make a physician stop and evaluate for rare conditions. This is a report of a teenager with multiple episodes of rhabdomyolysis and weakness. He was eventually diagnosed as having McArdle muscular dystrophy, or glycogen storage disease type V. His rhabdomyolysis has been severe, with a creatinine kinase level of >320,000 U/L, myoglobinuria, transaminitis, and elevated bilirubin. He has a low threshold for triggering rhabdomyolysis, such as doing an hour of aerobic exercise 2 days in a row. McArdle disease is a glycogen storage disorder in which the skeletal muscle cannot convert glycogen to glucose. Unlike other glycogen storage disorders, McArdle muscular dystrophy only affects the skeletal muscle, sparing the brain and visceral organs, leading to a vague phenotype. These patients have exercise intolerance, muscle cramps, and rhabdomyolysis. Many patients report loading with simple carbohydrates before exercise, as they have learned that this can increase their stamina. The vague symptoms can lead to decades of delay in diagnosis and significant mismanagement. Rhabdomyolysis is the most dangerous sign of McArdle disease, and it can lead to acute kidney injury, resulting in renal failure requiring dialysis in the severest cases.Rhabdomyolysis has numerous causes, but when it is recurrent, especially with seemingly insignificant triggers, one needs to develop a broader differential and pursue advanced testing. This testing can include specific exercise tests, genetic sequencing, and muscle biopsy. This case report will guide the clinician through the process of evaluating recurrent rhabdomyolysis, working through the differential diagnosis and testing options.1.
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Affiliation(s)
| | | | - Laurie Marzullo
- Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL
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Hamadeh M, Nasrallah K, Ajami Z, Zeaiter R, Abbas L, Hamadeh S, Fares J. Clinical Presentation and Management of Severe Acute Renal Failure in McArdle Disease. Clin Med Res 2021; 19:90-93. [PMID: 33985978 PMCID: PMC8231694 DOI: 10.3121/cmr.2021.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/20/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
McArdle disease, also known as glycogen storage disease type V, is an autosomal recessive disease due to the absence of myophosphorylase activity, leading to the complete disruption of glycogen breakdown in muscles. We present a rare case of a Caucasian male, aged 26 years, who developed rhabdomyolysis-induced acute renal failure and uremic encephalopathy. Neurological examination and histopathological studies supported the diagnosis of McArdle disease. The severity of his symptoms necessitated urgent hemodialysis, upon which the patient reported improvement in status. Acute renal failure in McArdle disease usually resolves with supportive treatment and maintenance of regular physical activity. Nevertheless, in more severe cases, intensive care with urgent hemodialysis may be needed. A multidisciplinary approach is necessary for the adequate management of similar cases.
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Affiliation(s)
- Majdi Hamadeh
- Lebanese University Faculty of Medicine, Beirut, Lebanon
- Al-Zahraa Hospital University Medical Center, Beirut, Lebanon
| | - Khalil Nasrallah
- Lebanese University Faculty of Medicine, Beirut, Lebanon
- Al-Zahraa Hospital University Medical Center, Beirut, Lebanon
| | - Zeinab Ajami
- Lebanese University Faculty of Medicine, Beirut, Lebanon
- Al-Zahraa Hospital University Medical Center, Beirut, Lebanon
| | - Rahil Zeaiter
- Lebanese University Faculty of Medicine, Beirut, Lebanon
- Al-Zahraa Hospital University Medical Center, Beirut, Lebanon
| | - Layan Abbas
- Lebanese University Faculty of Medicine, Beirut, Lebanon
- Al-Zahraa Hospital University Medical Center, Beirut, Lebanon
| | | | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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11
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Nemet D, Eliakim A. [MCARDLE'S DISEASE AND PHYSICAL ACTIVITY - A MIXED BLESSING]. Harefuah 2021; 160:377-381. [PMID: 34160155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
McArdle disease (Glycogen storage disease type V) is a myopathy caused by an inherited deficit of muscle glycogen phosphorylase (PYGM). Since glycogen is an important fuel for muscular activity, people with McArdle's disease experience exercise intolerance. Dynamic or static vigorous exercise may lead to rhabdomyolysis, myoglobinuria and renal failure. Although exercise intolerance appears early in childhood, most people with McArdle's disease are diagnosed in the second or third decade of life. People with McArdle's disease tend to avoid exercise, despite its clear beneficial effects on health. As with many chronic diseases, medically supervised exercise with proper nutrition is possible, important, and beneficial to people with McArdle's disease.
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Affiliation(s)
- Dan Nemet
- Child Health and Sports Center, Meir Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
| | - Alon Eliakim
- Child Health and Sports Center, Meir Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
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Lau NKC, Chong YK, Cheung KPK, Loo KT, Ching CK. McArdle disease presenting as abnormal liver function: biochemical, anatomical and genetic characterisation in the first genetically confirmed Chinese family with a novel splicing variant. Pathology 2020; 53:670-673. [PMID: 33309034 DOI: 10.1016/j.pathol.2020.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Nike Kwai Cheung Lau
- Kowloon West Cluster Laboratory Genetic Service, Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong
| | - Yeow Kuan Chong
- Kowloon West Cluster Laboratory Genetic Service, Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong
| | | | - Ka Tai Loo
- Department of Pathology, Tuen Mun Hospital, Hong Kong
| | - Chor Kwan Ching
- Kowloon West Cluster Laboratory Genetic Service, Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong.
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13
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Gomes CP, da Silva AMS, Zanoteli E, Pesquero JB. A new mutation in PYGM causing McArdle disease in a Brazilian patient. Acta Neurol Belg 2020; 120:705-707. [PMID: 31175620 DOI: 10.1007/s13760-019-01159-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Caio Perez Gomes
- Department of Biophysics, Center for Research and Molecular Diagnosis of Genetic Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Edmar Zanoteli
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - João Bosco Pesquero
- Department of Biophysics, Center for Research and Molecular Diagnosis of Genetic Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
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14
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Xie RR, Yang YB, Jin P. Identification of a novel PYGM mutation in a McArdle disease patient misdiagnosed as hypokalemic periodic paralysis. J Endocrinol Invest 2020; 43:697-698. [PMID: 32100198 DOI: 10.1007/s40618-020-01202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- R R Xie
- Department of Endocrinology, The Third Xiangya Hospital Central South University, Tongzipo Road, Hunan Province, 410007, Changsha, People's Republic of China
| | - Y B Yang
- Department of Endocrinology, The Third Xiangya Hospital Central South University, Tongzipo Road, Hunan Province, 410007, Changsha, People's Republic of China
| | - P Jin
- Department of Endocrinology, The Third Xiangya Hospital Central South University, Tongzipo Road, Hunan Province, 410007, Changsha, People's Republic of China.
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Horino T, Amano E, Furushima T, Ichii O, Terada Y. Spondyloarthropathy associated with glycogen storage disease type V mimicking polymyositis. QJM 2019; 112:281-282. [PMID: 30608612 DOI: 10.1093/qjmed/hcy309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Horino
- From the Department of Endocrinology, Metabolism and Nephrology, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - E Amano
- From the Department of Endocrinology, Metabolism and Nephrology, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - T Furushima
- Department of Neurology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - O Ichii
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-Ku, Sapporo, Japan
| | - Y Terada
- From the Department of Endocrinology, Metabolism and Nephrology, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
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16
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Satoh A, Hirashio S, Arima T, Yamada Y, Irifuku T, Ishibashi H, Motoda A, Sueda Y, Masaki T. Novel Asp511Thr mutation in McArdle disease with acute kidney injury caused by rhabdomyolysis. CEN Case Rep 2019; 8:194-199. [PMID: 30900170 DOI: 10.1007/s13730-019-00392-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/10/2019] [Indexed: 01/06/2023] Open
Abstract
McArdle disease (glycogen storage disease type V) is a rare hereditary metabolic myopathy. It can be overlooked clinically because it often presents as chronic asymptomatic hypercreatine phosphokinasemia (hyperCKemia). However, vigorous exercise or infections can trigger severe rhabdomyolysis. We present the case of a patient with long-term idiopathic hyperCKemia who, after contracting an upper respiratory tract infection, developed severe rhabdomyolysis and acute kidney injury. Upon hemodialysis, his renal function recovered and CK levels fell to below baseline, and maintenance therapy with vitamin B6 was also started. A molecular diagnosis of McArdle disease was subsequently made. Whole-exome sequencing revealed homozygous c1538delG (p.Asp511Thr fs*28) mutations in the PYGM gene, which was a novel mutation. Therefore, when investigating idiopathic hyperCKemia, glycogen storage disorders should also be considered.
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Affiliation(s)
- Ayaka Satoh
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
- Department of Nephrology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Shuma Hirashio
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
- Department of Nephrology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Takahiro Arima
- Department of Nephrology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Yumi Yamada
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
- Department of Nephrology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Taisuke Irifuku
- Department of Nephrology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Haruka Ishibashi
- Department of Neurology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Atsuko Motoda
- Department of Neurology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Yoshimasa Sueda
- Department of Neurology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan.
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17
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Núñez-Manchón J, Ballester-Lopez A, Koehorst E, Linares-Pardo I, Coenen D, Ara I, Rodriguez-Lopez C, Ramos-Fransi A, Martínez-Piñeiro A, Lucente G, Almendrote M, Coll-Cantí J, Pintos-Morell G, Santos-Lozano A, Arenas J, Martín MA, de Castro M, Lucia A, Santalla A, Nogales-Gadea G. Manifesting heterozygotes in McArdle disease: a myth or a reality-role of statins. J Inherit Metab Dis 2018; 41:1027-1035. [PMID: 29926259 DOI: 10.1007/s10545-018-0203-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/15/2018] [Accepted: 05/18/2018] [Indexed: 11/26/2022]
Abstract
McArdle disease is an autosomal recessive condition caused by deficiency of the PYGM gene-encoded muscle isoform of glycogen phosphorylase. Some cases of "manifesting" heterozygotes or carriers (i.e., patients who show some McArdle-like symptoms or signs despite being carriers of only one mutated PYGM allele) have been reported in the literature but there is controversy, with misdiagnosis being a possibility. The purpose of our study was to determine if there are actually "manifesting" heterozygotes of McArdle disease and, if existing, whether statin treatment can trigger such condition. Eighty-one relatives of McArdle patients (among a total of 16 different families) were studied. We determined whether they were carriers of PYGM mutations and also collected information on exercise tests (second wind and modified Wingate anaerobic test) and statin intake. We found 50 carriers and 31 non-carriers of PYGM mutations. Although we found existence of heterozygotes manifesting some exercise-related muscle problems such as exacerbated myalgia or weakness, they only accounted for 14% of the carriers and muscle symptoms were milder than those commonly reported in patients. Further, no carrier (whether reporting symptoms or not) showed the second wind phenomenon or a flat blood lactate response to maximal-intensity exercise, both of which are hallmarks of McArdle disease. On the other hand, statin myotoxicity was not associated with muscle symptom onset.
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Affiliation(s)
- Judit Núñez-Manchón
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Alfonsina Ballester-Lopez
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Emma Koehorst
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Ian Linares-Pardo
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Daniëlle Coenen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Madrid, Spain
- CIBER of Frailty and Healthy Aging (CIBER FES), Madrid, Spain
| | - Carlos Rodriguez-Lopez
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Madrid, Spain
- CIBER of Frailty and Healthy Aging (CIBER FES), Madrid, Spain
| | - Alba Ramos-Fransi
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Neuromuscular Pathology Unit, Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alicia Martínez-Piñeiro
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Neuromuscular Pathology Unit, Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Giuseppe Lucente
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Neuromuscular Pathology Unit, Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Miriam Almendrote
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Neuromuscular Pathology Unit, Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jaume Coll-Cantí
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Pathology Unit, Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Guillem Pintos-Morell
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Division of Rare Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Santos-Lozano
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain
| | - Joaquin Arenas
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Miguel Angel Martín
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Mauricio de Castro
- United States Air Force Medical Genetics Center, 81st Medical Group, Keesler AFB, Biloxi, MS, 39534, USA
| | - Alejandro Lucia
- CIBER of Frailty and Healthy Aging (CIBER FES), Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Universidad Europea de Madrid (Faculty of Sport Sciences), Madrid, Spain
| | - Alfredo Santalla
- CIBER of Frailty and Healthy Aging (CIBER FES), Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Universidad Pablo de Olavide, Sevilla, Spain
| | - Gisela Nogales-Gadea
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
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Abstract
PURPOSE OF REVIEW Metabolic myopathies are genetic disorders that impair intermediary metabolism in skeletal muscle. Impairments in glycolysis/glycogenolysis (glycogen-storage disease), fatty acid transport and oxidation (fatty acid oxidation defects), and the mitochondrial respiratory chain (mitochondrial myopathies) represent the majority of known defects. The purpose of this review is to develop a diagnostic and treatment algorithm for the metabolic myopathies. RECENT FINDINGS The metabolic myopathies can present in the neonatal and infant period as part of more systemic involvement with hypotonia, hypoglycemia, and encephalopathy; however, most cases present in childhood or in adulthood with exercise intolerance (often with rhabdomyolysis) and weakness. The glycogen-storage diseases present during brief bouts of high-intensity exercise, whereas fatty acid oxidation defects and mitochondrial myopathies present during a long-duration/low-intensity endurance-type activity or during fasting or another metabolically stressful event (eg, surgery, fever). The clinical examination is often normal between acute events, and evaluation involves exercise testing, blood testing (creatine kinase, acylcarnitine profile, lactate, amino acids), urine organic acids (ketones, dicarboxylic acids, 3-methylglutaconic acid), muscle biopsy (histology, ultrastructure, enzyme testing), MRI/spectroscopy, and targeted or untargeted genetic testing. SUMMARY Accurate and early identification of metabolic myopathies can lead to therapeutic interventions with lifestyle and nutritional modification, cofactor treatment, and rapid treatment of rhabdomyolysis.
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Quinlivan R, Andreu AL, Marti R. 211th ENMC International Workshop:: Development of diagnostic criteria and management strategies for McArdle Disease and related rare glycogenolytic disorders to improve standards of care. 17-19 April 2015, Naarden, The Netherlands. Neuromuscul Disord 2017; 27:1143-1151. [PMID: 29079393 DOI: 10.1016/j.nmd.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Ros Quinlivan
- MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Antoni L Andreu
- Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | - Ramon Marti
- Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBERER, Barcelona, Catalonia, Spain
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20
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Abstract
CASE McArdle disease, a glycogen storage disorder, often manifests as exercise intolerance secondary to muscle ischemia. Few authors have reported on rhabdomyolysis or compartment syndrome following inciting events among patients with McArdle disease. We present the case of a 40-year-old woman who developed spontaneous compartment syndrome of the right forearm and subsequently underwent emergency fasciotomy. CONCLUSION On the basis of the present case and our review of the current literature, we advocate a high level of suspicion for compartment syndrome in patients with a history of McArdle disease.
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Affiliation(s)
| | | | - Benjamin Taylor
- OhioHealth Orthopedic Trauma and Reconstruction Surgeons, Grant Medical Center, Columbus, Ohio
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Scalco RS, Chatfield S, Junejo MH, Booth S, Pattni J, Godfrey R, Quinlivan R. McArdle Disease Misdiagnosed as Meningitis. Am J Case Rep 2016; 17:905-908. [PMID: 27899787 PMCID: PMC5131610 DOI: 10.12659/ajcr.900967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/14/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND McArdle disease is a glycogen storage disorder mainly characterized by exercise intolerance. Prolonged muscle contracture is also a feature of this condition and may lead to rhabdomyolysis (RM), which is a serious event characterized by acute skeletal muscle damage. CASE REPORT A 44-year-old female patient presented with an acute contracture of the posterior neck muscles, causing severe nuchal rigidity. The contracture was induced during a dental extraction as she held her mouth open for a prolonged period, with her neck in a rigid position. She presented with severe pain in her ear and head, as well as fever, vomiting, and confusion. Based on her symptoms, she was initially misdiagnosed with bacterial meningitis and experienced an acute allergic reaction to the systemic penicillin she was subsequently administered. Lumbar puncture results were normal. High serum creatine kinase (CK) levels, recurrent exercise-related muscle symptoms, and a previous history of recurrent myoglobinuria raised the suspicion of an underlying neuromuscular condition. McArdle disease was confirmed by muscle biopsy and a genetic test, which revealed that the patient was homozygous for the R50X mutation in the PYGM gene. CONCLUSIONS This case illustrates that even seemingly innocuous movements, if rapid isotonic or prolonged isometric in nature, can elicit a muscle contracture in McArdle disease patients. Here, we highlight the need for careful management in this patient population even during routine healthcare procedures. The allergic reaction to antibiotics emphasises that misdiagnoses may result in iatrogenic harm.
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Affiliation(s)
- Renata Siciliani Scalco
- MRC Centre for Neuromuscular Diseases and Division of Neuropathology, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, U.K
- CAPES Foundation, Ministry of Education, Brasilia, Brazil
| | - Sherryl Chatfield
- MRC Centre for Neuromuscular Diseases and Division of Neuropathology, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, U.K
| | | | - Suzanne Booth
- MRC Centre for Neuromuscular Diseases and Division of Neuropathology, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, U.K
| | - Jatin Pattni
- MRC Centre for Neuromuscular Diseases and Division of Neuropathology, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, U.K
| | - Richard Godfrey
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, London, U.K
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases and Division of Neuropathology, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, U.K
- Dubowitz Neuromuscular Centre, Great Ormond Street Hospital, London, U.K
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22
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Abstract
Two cases of hypercholesterolaemic patients are presented in whom raised plasma creatine kinase was noted during treatment with statins. The plasma creatine kinase failed to fall following cessation of therapy. Further investigation revealed the aetiology of the raised plasma creatine kinase to be due to previously undiagnosed glycogen storage diseases (McArdle's and Pompe's diseases).
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Affiliation(s)
- J H Barth
- Department of Clinical Biochemistry and Immunology, Leeds General Infirmary, Leeds LS1 3EX, UK.
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23
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Abstract
We describe the case of a 69-year-old man with a history of muscular symptoms dating back to his childhood; McArdle's disease (glycogen-storage disease V) was diagnosed following an episode of myositis in which a statin and physical exertion appear to have been precipitating factors. This case demonstrates that the ischaemic lactate-ammonia test still has a place in screening patients with symptoms suggestive of McArdle's disease and emphasizes the importance of carrying out glycogen phosphorylase histochemistry on the skeletal muscle biopsy to confirm the diagnosis. In patients who develop a raised plasma creatine kinase level or muscular symptoms during lipid-lowering therapy, the clinician should be alert to the possibility of an underlying myopathy.
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Affiliation(s)
- Callum Livingstone
- Department of Clinical Biochemistry, Royal Surrey County Hospital, Guildford GU2 7XX, UK.
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24
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Mull AB, Wagner JI, Myckatyn TM, Kells AF. Recurrent Compartment Syndrome Leading to the Diagnosis of McArdle Disease: Case Report. J Hand Surg Am 2015; 40:2377-9. [PMID: 26612634 DOI: 10.1016/j.jhsa.2015.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 02/02/2023]
Abstract
Glycogen storage disorders are rare diseases of metabolism that are usually diagnosed when a patient presents with recurrent fatigue, muscle pains, and exercise intolerance. In this case report, we describe a patient who presented with the second episode of nontraumatic compartment syndrome over a 10-year span. Because of the obscure presentation, we performed a muscle biopsy, which on muscle phosphorylase staining revealed McArdle disease (glycogen storage disease type V).
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Affiliation(s)
- Aaron B Mull
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO.
| | - Janelle I Wagner
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | | | - Amy F Kells
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO
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25
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Tarui S, Kono N, Kuwajima M, Ikura Y. Type VII glycogenosis (muscle and erythrocyte phosphofructokinase deficiency). Monogr Hum Genet 2015; 9:42-7. [PMID: 153468 DOI: 10.1159/000401609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Affiliation(s)
- Marta Almeida Ferreira
- Largo Professor Abel Salazar, Hospital de Santo António, Edifício Neoclássico, 4099-001, Porto, Portugal,
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27
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Park HJ, Shin HY, Cho YN, Kim SM, Choi YC. The significance of clinical and laboratory features in the diagnosis of glycogen storage disease type v: a case report. J Korean Med Sci 2014; 29:1021-4. [PMID: 25045239 PMCID: PMC4101771 DOI: 10.3346/jkms.2014.29.7.1021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/08/2014] [Indexed: 11/20/2022] Open
Abstract
Glycogen storage disease type V (GSD-V) is the most common disorder of muscle glycogenosis with characteristic clinical and laboratory findings. A 32-yr-old woman complained of exercise intolerance and myoglobulinuria since early adolescence. She reported several episodes of second-wind phenomenon. Physical examination did not show any neurological abnormality, including fixed muscle weakness or atrophy. Serum creatine kinase level was 1,161 IU/L at rest. The result of the non-ischemic forearm exercise test was compatible with GSD-V. Mutation analysis identified the compound heterozygous mutations of the PYGM, p.D510fs and p.F710del, which has not yet been reported in Korea. The present case recognizes that detail clinical and laboratory analysis is the first step in the diagnosis of GSD-V.
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Affiliation(s)
- Hyung Jun Park
- Department of Neurology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Na Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
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28
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Keel BR, Brit M. McArdle's disease: a clinical review and case report. Tenn Med 2013; 106:33-37. [PMID: 24282836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
McArdle's Disease is a rare glycogen disease involving deficiency in muscle phosphorylase. This deficiency can lead to rhabdomyolysis and subsequently renal failure. McArdle's Disease has a similar presentation as several other metabolic myopathies with exercise-induced fatigue, myalgias, weakness or unexplained rhabdomyolysis. Suspicion should be raised in the presence of unexplained symptoms, and muscle biopsy can be done to confirm the diagnosis.
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29
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Cosentini V, Cosaro A, Gammaro L, Tonin P, Scarpelli M, Campo S, Oldrizzi L. [A case of acute renal failure secondary to late-onset McArdle's disease]. G Ital Nefrol 2013; 30:gin/00075.17. [PMID: 23832480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Mc Ardles disease, also known as Type V glycogen storage disease, is a rare deficiency of the enzyme glycogen phosphorylase in muscle cells, inherited as an autosomal recessive trait. In the absence of this enzyme, muscles cannot break down glycogen during exercise, so in patients affected by McArdles disease even moderate physical activity produces cramps, pain and fatigue. Anaerobic activity leads to severe fixed contractures and rhabdomyolisis with myoglobinuria and raised serum creatine-kinase, which, in turn, can lead to acute renal failure. Disease onset is usually in early childhood, although diagnosis is often not made until the second or third decade. CASE REPORT We present the case of a 68-year-old man who presented to the Emergency Room with fatigue, vertigo, diarrhea and oliguria. The patient underwent five daily hemodialysis sessions, diuresis reappeared and there was progressive recovery of renal function. The patient described episodes of fatigue and muscular pain occurring since childhood: the positive personal history, together with persistently raised CPK levels in the absence of any infective or toxic cause of myositis, led us to suspect the presence of this rare metabolic disease, which was subsequently confirmed by muscle biopsy. CONCLUSION To date, there is no specific treatment for type V glycogenosis, although a diet rich in protein and saccarose, vitamin B6 supplementation and creatine administration are generally recommended. Moderate physical activity can help manage symptoms by improving exercise tolerance and blood supply to the muscles, ensuring provision of glucose and free fatty acids for the muscle fibers.
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Fikri-Benbrahim O, Cazalla-Cadenas F, Vadillo-Bemejo A. From acute renal failure to the diagnosis of McArdle's disease. Nefrologia 2013; 33:605-606. [PMID: 23897197 DOI: 10.3265/nefrologia.pre2013.feb.11885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 06/02/2023] Open
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31
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Moore DM, Nadarajan P, Hawksworth R, Lane SJ, Graham IM. Exercise induced fatigue: unfit or unwell? Ir Med J 2011; 104:151. [PMID: 21736093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This case report outlines the diagnoses of a rare myophosphorylase deficiency (McArdle Syndrome) in a unique way. A set of characteristic values from a Cardiopulmonary Exercise Test (CPET) combined with a typical patient history pointed to a failure of the glycolytic pathway in the skeletal muscle. McArdle Syndrome was confirmed with a skeletal muscle biopsy. There is no evidence of such a diagnostic method in the literature.
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32
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Koenraads M, den Boer JA, Kerkhoff H, Sas TCJ. [Myalgia during warming-up in a 12-year-old boy]. Ned Tijdschr Geneeskd 2011; 155:A2668. [PMID: 21527049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION McArdle disease is a hereditary myopathy caused by muscle phosphorylase deficiency. Patients experience painful muscle cramps after strenuous exercise; the condition is sometimes associated with rhabdomyolysis, myoglobinuria and resulting acute renal failure. CASE DESCRIPTION A 12-year-old boy visited the Paediatric and Neurology outpatients' departments with symptoms of leg myalgia, occurring during the warming-up phase of soccer practice, which disappeared after a short rest. Detailed history-taking revealed that he already experienced pain while walking during early childhood. An elevated serum creatine kinase concentration in combination with the typical presentation led to the presumptive diagnosis 'McArdle disease', which was confirmed by molecular genetic analysis. CONCLUSION There is no effective gene therapy; a multidisciplinary approach by a neurologist, paediatrician, physiotherapist and nutritionist is advised.
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33
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Abstract
McArdle disease is a glycogenetic myopathy caused by a deficit of myophosphorylase inherited in an autosomal recessive pattern. Here, we report a case of McArdle disease in which fatigability was the only subjective complaint. Objective neurological findings were normal except for very mild muscle weakness in limbs and an elevated serum creatine kinase level. Ischemic forearm exercise test showed deficient glycogenolysis. In the muscle biopsy specimen, periodic acid Schiff (PAS) stained subsarcolemmal glycogen was increased and the muscle phosphorylase A activity was decreased. After administration of vitamin B6, fatigability was diminished and ischemic forearm exercise test showed improved glycogenolysis. Vitamin B6 may be beneficial for McArdle disease, especially for its easy fatigability.
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Affiliation(s)
- Rumiko Izumi
- Department of Neurology, Tohoku University School of Medicine, Sendai
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34
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Coates RA. How sweet it is: McArdle's disease case report and discussion. J Insur Med 2009; 41:136-141. [PMID: 19845217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Robert A Coates
- RGA, 1370 Timberlake Manor Parkway, Chesterfield, MO 63017, USA
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35
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Laforêt P. [Actions to be taken in case of muscle exercise intolerance]. Rev Prat 2008; 58:2261-2264. [PMID: 19209657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Pascal Laforêt
- Centre de référence de pathologie neuromusculaire Paris-Est, Institut de myologie, groupe hospitalier La Pité-Salpêtrière, 75651 Paris Cedex 13, France.
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Noshad H, Sadreddini S, Ghaffari AR. Recurrent acute kidney failure due to McArdle disease. Iran J Kidney Dis 2008; 2:234-236. [PMID: 19377243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present an adolescent with McArdle disease and recurrent acute kidney failure due to rhabdomyolysis. The patient was admitted with acute kidney failure for 3 times and due to a history of proximal weakness, fatigue, and muscular cramps after physical activities a glycogen-storage disease was suspected. Serum creatine phosphokinase and urine myoglobin were found to be elevated. McArdle disease was diagnosed based on pathologic examination of muscle tissue specimen. Patients presenting with rhabdomyolysis following strenuous exercise should be evaluated for McArdle disease.
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Affiliation(s)
- Hamid Noshad
- Division of Nephrology, Department of Medicine, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
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Flavier S, Rolland MO, Eude M, Fédou C, Brun JF, Maire I, Mercier J, Raynaud E. [Late diagnosis of a McArdle disease's case (type V glycogenosis)]. Ann Biol Clin (Paris) 2007; 65:550-4. [PMID: 17913675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 06/23/2007] [Indexed: 05/17/2023]
Abstract
McArdle's disease is a metabolic myopathy characterized by a myophosphorylase deficiency resulting in an inability to degrade glycogen stores. We report the case of a 48 years old patient who complained since adolescence of rest and exercise myalgias and presented a chronic increased plasma creatine kinase activity. First, a maximal exercise test was performed. This test demonstrated a quasi lack of rise of respiratory exchange ratio and of blood lactate, possibly due to a glycogenolytic/glycolytic pathway deficiency. Second, a biopsy of vastus lateralis muscle was performed using Bergström needle. As expected, the analysis of mitochondrial function was normal. The in vitro screening test of the glycogenolysis/glycolysis pathway showed a lack of lactate production in presence of glycogen substrate. The study of muscular metabolism of glycogen revealed a glycogen accumulation and a decrease of active and total phosphorylase activities. These data allowed us to diagnose a type V glycogenosis, or McArdle's disease. The patient appeared heterozygous for the most frequent mutation (p.R50X).
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Affiliation(s)
- S Flavier
- Service central de physiologie clinique, Unité d'exploration métabolique (CERAMM), Hôpital Lapeyronie, CHU de Montpellier et Inserm, équipe ERI 25 / EA 4202 Muscle et pathologies, Montpellier
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Loupy A, Pouchot J, Hertig A, Bonnard G, Bouvard E, Rondeau E. Rhabdomyolyse massive révélant une maladie de McArdle. Rev Med Interne 2007; 28:501-3. [PMID: 17383055 DOI: 10.1016/j.revmed.2007.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 02/14/2007] [Indexed: 11/21/2022]
Abstract
INTRODUCTION McArdle's disease is an autosomal recessive glycogenosis caused by deficiency of muscle glycogen phosphorylase resulting in glycogen accumulation in the skeletal muscle. Typically, McArdle's disease is characterized by exercise intolerance with muscle cramps and myoglobinuria. CASE REPORT We report a 20-year-old woman with massive rhabdomyolysis and acute renal failure revealing a McArdle's disease. DISCUSSION Although muscle impairment is constant in McArdle's disease, massive rhabdomyolysis with severe acute renal failure has been rarely reported as a presenting feature. The mechanisms and therapeutic implications of renal injury are discussed.
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Affiliation(s)
- A Loupy
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Abstract
In 1951, McArdle described a glycogen storage disorder which presents primarily as a myopathy. It is characterized by muscle pain, weakness and exercise intolerance with elevated creatine kinase from rhabdomyolysis. The pathophysiology involves a deficiency of myophosphorylase enzyme resulting in an inability to degrade glycogen stores. We present a novel case of McArdle disease (glycogen storage disease V [GSDV]) in a patient who had sickle cell trait and bulimia. The disease went unrecognized despite several admissions to the hospital with increased creatine kinase and muscle myopathy until the patient's initial presentation with acute renal failure.
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Rubio JC, Garcia-Consuegra I, Nogales-Gadea G, Blazquez A, Cabello A, Lucia A, Andreu AL, Arenas J, Martin MA. A proposed molecular diagnostic flowchart for myophosphorylase deficiency (McArdle disease) in blood samples from Spanish patients. Hum Mutat 2007; 28:203-4. [PMID: 17221871 DOI: 10.1002/humu.9474] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
McArdle disease is a metabolic myopathy due to molecular defects in the myophosphorylase gene (PYGM), usually diagnosed in muscle biopsy. The aims of this study were to characterize genetically a large series of patients and to establish a protocol of molecular diagnosis on blood samples. We studied 55 Spanish unrelated patients with McArdle disease. Screening for the three more frequent mutations in the PYGM gene in the Spanish population (c.148C>T, p.R50X; c.613G>A, p.G205S; and c.2392T>C, p.W798R) were performed with polymerase chain-reaction and restriction fragment length polymorphism (PCR-RFLP) methods. To identify other mutant alleles, the coding region of PYGM gene was sequenced. The p.R50X mutation was observed in 38 patients, the p.G205S substitution in eight, and the p.W798R change in nine. Nine novel mutations, five missense (c.247A>T, p.I83F; c.521G>A, p.G174D; c.1094C>T, p.A365V; c.1468C>T, p.R490W; and c.1730A>G, p.Q577R), one nonsense mutation (c.2352C>A, p.C784X), three frameshift (c.402del, p.N134KfsX161; c.212_218dup, p.Q73HfsX7; c.1470dup, p.R491AfsX7), and nine previously reported mutations were found. In addition, we also updated the molecular data of 95 unrelated patients with McArdle disease studied thus far in our center. Of these patients, 56 were either homozygous or compound heterozygous for the p.R50X, p.G205S, or p.W798R mutation. By including in the molecular diagnosis protocol sequencing of the exons 1, 14, 17 and 18 of the PYGM gene, 16 further patients were characterized, and therefore we were able to detect the molecular defect in 72 out of 95 patients. A proposed molecular diagnosis protocol of the disease based on blood DNA would avoid muscle biopsy in 75.8% [95% confidence interval (95% CI): 62.1%-78.6%] of patients with McArdle disease.
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Affiliation(s)
- Juan C Rubio
- Centro de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
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41
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Grassi B, Marzorati M, Lanfranconi F, Ferri A, Longaretti M, Stucchi A, Vago P, Marconi C, Morandi L. Impaired oxygen extraction in metabolic myopathies: Detection and quantification by near-infrared spectroscopy. Muscle Nerve 2007; 35:510-20. [PMID: 17143893 DOI: 10.1002/mus.20708] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients with mitochondrial myopathies (MM) or myophosphorylase deficiency (McArdle's disease, McA) show impaired capacity for O(2) extraction, low maximal aerobic power, and reduced exercise tolerance. Non-invasive tools are needed to quantify the metabolic impairment. Six patients with MM, 6 with McA, 25 with symptoms of metabolic myopathy but negative biopsy (patient-controls, P-CTRL) and 20 controls (CTRL) underwent an incremental cycloergometric test. Pulmonary O(2) uptake (VO(2)) and vastus lateralis oxygenation indices (by near-infrared spectroscopy, NIRS) were determined. Concentration changes of deoxygenated hemoglobin and myoglobin (Delta[deoxy(Hb + Mb)]) were considered an index of O(2) extraction. Delta[deoxy(Hb + Mb)] peak (percent limb ischemia) was lower in MM (25.3 +/- 12.0%) and McA (18.7 +/- 7.3) than in P-CTRL (62.4 +/- 3.9) and CTRL (71.3 +/- 3.9) subjects. VO(2) peak and Delta[deoxy(Hb + Mb)] peak were linearly related (r(2) = 0.83). In these patients, NIRS is a tool to detect and quantify non-invasively the metabolic impairment, which may be useful in the follow-up of patients and in the assessment of therapies and interventions.
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Affiliation(s)
- Bruno Grassi
- Department of Science and Biomedical Technologies, University of Milan, LITA-Via Fratelli Cervi 93, I-20090 Segrate, MI, Italy.
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Abstract
The authors investigated whether carriers of single myophosphorylase gene (PYGM) mutations have symptoms of McArdle disease. They studied the oxidative capacity and lactate responses to maximal cycle exercise in eight patients with McArdle disease, seven single PYGM mutation carriers, and 11 healthy subjects. Heterozygotes had maximal oxidative capacity and peak lactate responses identical to control subjects. Thus, carriers of single PYGM mutations are not prone to develop symptoms of McArdle disease.
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Affiliation(s)
- Susanne Tvede Andersen
- Neuromuscular Research Unit, Department of Neurology, Copenhagen Muscle Research Center, Denmark
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Fernandez C, de Paula AM, Figarella-Branger D, Krahn M, Giorgi R, Chabrol B, Monfort MF, Pouget J, Pellissier JF. Diagnostic evaluation of clinically normal subjects with chronic hyperCKemia. Neurology 2006; 66:1585-7. [PMID: 16717227 DOI: 10.1212/01.wnl.0000216144.69630.6e] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors analyzed muscle biopsy specimens of 104 patients with creatine kinase activity greater than 500 UI/L (normal 10 to 170 UI/L) without signs of muscle weakness. They achieved a definite or probable diagnosis in 55% of cases. The most frequently identified diseases were glycogen storage diseases, muscular dystrophies, and inflammatory myopathies. The probability of making a diagnosis was higher in children and when creatine kinase level was greater than 2,000 UI/L.
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Affiliation(s)
- C Fernandez
- Laboratoire d'Anatomie Pathologique et Neuropathologie, Hôpital de la Timone Adultes, Marseille, France
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Abstract
Neuromuscular disorders represent a large group of highly varied and interesting clinical disorders, many of which have major general medical manifestations. These disorders can be diagnosed largely based on the patient's history and physical examination with a little help from modern technology. Despite the outdated belief that neurologic conditions are diagnosed but rarely treatable, all cases discussed herein represent disorders for which there are extensive options and opportunities for meaningful management. These 16 brief case overviews challenge and refresh diagnostic skills and provide the framework for selected comments regarding management options.
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Affiliation(s)
- Jay R Bhatt
- Department of Neurology, Indiana University School of Medicine, 1120 South Drive, Indianapolis, IN 46202, USA
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Abstract
Improvements to restriction fragment length polymorphism (RFLP)-based genotyping assays currently used for detection of mutations responsible for bovine ferrochelatase and myophosphorylase deficiencies, and equine hyperkalemic periodic paralysis (HYPP) are described. Reports of sporadic inhibition of restriction enzyme activity suggest a critical factor in RFLP-based genotyping assays should be assurance that restriction enzymes perform to specification with every sample. The RFLP genotyping assays that use either a mismatched recognition sequence in one or both of the oligonucleotides, or incorporate a second native site within the PCR amplicon, provide the mechanism by which efficiency of restriction enzymes can be assessed with every sample. The outcome is confirmation of the activity of the discriminating enzyme regardless of genotype.
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Affiliation(s)
- Brendon A O'Rourke
- Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales, Australia.
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Sidhu N, Thompson T. McArdle's disease (myophosphorylase deficiency) presenting as acute renal failure. N Z Med J 2005; 118:U1614. [PMID: 16132075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Navdeep Sidhu
- Department of Medicine, Wanganui Hospital, Wanganui, New Zealand
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Olivé M, Casademont J. Varón de 24 años con intolerancia al esfuerzo. Med Clin (Barc) 2005; 124:308-13. [PMID: 15755394 DOI: 10.1157/13072327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Montserrat Olivé
- Institut de Neuropatologia, IDIBELL, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Abstract
McArdle's disease is a rare, inherited deficiency of myophosphorylase, an enzyme required for the utilization of glycogen. Patients with myophosphorylase deficiency classically present with exercise intolerance, leg pain and muscle fatigue. The case of a young woman with exertional dyspnea and leg cramps is described. Exercise testing confirmed the presence of exercise intolerance and demonstrated an accelerated heart rate response, despite the absence of an anaerobic threshold and a respiratory exchange ratio of less than 1.0. Subsequent ischemic forearm testing and muscle biopsy confirmed the diagnosis of myophosphorylase deficiency. Evaluation of lung mechanics with esophageal pressure measurements demonstrated the presence of respiratory muscle weakness and early fatiguability, suggesting that the patient's dyspnea might have been attributable to an increased respiratory effort. Dyspnea is not a classic symptom associated with myophosphorylase deficiency, although subclinical respiratory muscle impairment may be present. No previous studies have evaluated respiratory muscle function during exercise in patients with myophosphorylase deficiency.
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Affiliation(s)
- Nha Voduc
- Department of Medicine, Queen's University, Kingston, Ontario
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Sanjurjo E, Laguno M, Bedini JL, Miró O, Grau JM. Prueba de ejercicio con isquemia en el antebrazo. Estandarización y valor diagnóstico en la identificación de la enfermedad de McArdle. Med Clin (Barc) 2004; 122:761-6. [PMID: 15207103 DOI: 10.1016/s0025-7753(04)74380-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE The forearm ischemic exercise test (FIET) with serial lactate determinations is used worldwide for the screening of McArdle's disease and other glucogenosis. Yet there is no uniformity with regard to the intensity of the work and the ischemia time. The aim of this study was to standardize the test conditions in normal people and to check its efficacy in our population. PATIENTS AND METHOD In a first stage, we included 9 healthy persons in whom four different conditions were applied regarding the cuff pressure and ischemia time. In a second stage, 5 previously known McArdle disease patients, 30 normal individuals and 25 patients with a diagnosis of myopathy other than glucogenosis underwent FIET with the conditions standardized in the first stage. RESULTS The best curve profile was obtained with a cuff pressure 20 mm Hg above systolic blood pressure and with exercise until fatigue o cramps without time limitation. With a cut-point at 200% of the basal values of ammonium and lactate, the sensitivity and specificity of FIET were 100% and 96%, respectively, for McArdle's disease. No major side effects were recorded in any case. CONCLUSIONS Conditions of FIET have been standardized. Taking into account the high sensitivity and specificity of the test, its use should be considered in the screening of anaerobic metabolic myopathies.
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Affiliation(s)
- Eduard Sanjurjo
- Unidad de Investigación de Muscular, Servicio de Medicina Interna, Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universidad de Barcelona, Spain
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Pavic M, Petiot P, Streichenberger N, Dupond JL, Drouet A, Flocard F, Bouhour F, Colin JY, Bielefeld P, Gouttard M, Maire I, Pellat J, Vital Durand D, Rousset H. [Analysis of 12 cases of McArdle's disease diagnosed after 30 years]. Rev Med Interne 2003; 24:716-20. [PMID: 14604748 DOI: 10.1016/s0248-8663(03)00219-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE McArdle's disease (MAD) or glycogen storage disease type V, usually starts in childhood or adolescence. Generally diagnosis is made before the early adulthood because patients present well defined syndrome and are constrained. METHOD We retrospectively investigated all MAD cases diagnosed in the biochemical laboratory from Debrousse Hospital in Lyon, during 40 years (1962-2002). We then selected patients whose diagnosis had been made after 30 years. RESULTS Fifteen patients answered our criteria but only 11 files could be analysed. A twelfth patient (service of internal medicine--Royan) supplemented the series. We sought the reasons of a late diagnosis: early age of beginning but few symptoms (7 cases), age of beginning higher than 20 years (5 cases including 3 after 45 years). The principal symptoms were muscular deficit and muscular pains (8 cases) and second wind phenomenon (7 cases). Creatinine phosphokinase level was constantly high. Ischemic effort test when it was carried out was constantly abnormal. Conversely electromyogram was often normal (5 cases). Several biopsies were necessary in a third of the cases to evoke the diagnosis, particularly among the patients with late onset symptoms. CONCLUSION Diagnosis of metabolic MAD is generally easy if the interrogation finds inaugural symptoms in childhood or adolescence even if the patient consults very late in the life. The diagnosis can become much more difficult if it begins late in life (atypical symptoms, need for several muscular biopsy).
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Affiliation(s)
- M Pavic
- Service de médecine interne, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69998 Lyon Armées, France.
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