Mysterious CPK Level of 8220

[kca1136]

For the past couple of months, I have been going back and forth to the doctors, trying to diagnose this mysterious abnormality. Originally, I went to get a blood test to ensure my cholesterol was normal. It was, but my liver enzymes (ALT and AST) came back elevated. I got another set of blood tests, and they found that my LDH was elevated as well, about 9000, along with the slightly lowered, yet still high liver enzymes. The doctor was perplexed because I was not in any pain, and seemed clinically fine.
So, I go in for a third round of blood tests (keep in mind they keep testing me for new things) and discover my CPK is 7900, but my LDH is now 798. I had an ultrasound, and it was fine. Further testing shows that the CPK is the one from my muscle, yet I haven't experienced any muscle pain.
A recent blood test (my fourth one) shows that my CPK is now 8220, and I'm going in for an EMG soon.

Any ideas what this could be? My family has no history of muscle disorders.

[Lama Chahine, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your laboratory abnormalities is. However I will try to provide you with some useful information.

There are many many causes to elevated CPK. Medications are probably the most common, with the cholesterol medications (called as a group "statins") being the most common. Besides medications, various muscle disorders, including autoimmune, inflammatory, genetic, infectious (viruses most commonly) and acquired disorders can also cause elevated CPK. An elevated CPK is most often a marker of muscle tissue breakdown. However, there is a condition called "idiopathic hyper-CKinemia" which is just an elevated CPK, without an identifiable cause, and with no clinical implications. However, the latter is a diagnosis of exclusion: other causes of elevated CPK must be ruled out. Have an EMG is on the right track for this.

LDH is an enzyme (a protein) found in many tissues in the body, including the muscles in addition to many others. There are many non-neurologic causes of LDH, but in general an elevated LDH indicates some sort of tissue damage, such as due to infection, blood breakdown (what is called hemolytic anemia), other blood disorders, and several others.

It sounds like you are on the right track with an EMG ordered, continued follow-up with an internist is recommenced. Evaluation by neuromuscular specialist (a neurologist specialized in muscle and nerve disorders) may be of benefit to you.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[kca1136]

I have never heard of idiopathic hyper-CKinemia but that definitely seems interesting.  If the EMG doesn't have any conclusive results then that might definitely be something I should talk to my neurologist about.

Thank you so much!