2025 American Academy of Neurology Abstract Website

Objective:

To identify the utility of measuring serum aldolase in patients with possible myopathy.

Background:

Myopathies can be challenging to recognize and diagnose. While creatine kinase (CK) is often elevated, aldolase may be selectively elevated when CK is normal. Few studies have analyzed the frequency of elevated aldolase levels and how often this finding might guide diagnosis.

Design/Methods:

Patients with aldolase levels measured for the first time at our medical center between January 2022 and December 2022 were retrospectively reviewed. Aldolase levels and CK levels for each patient were documented. Frequencies of normal or elevated aldolase and normal or elevated CK were calculated. A final diagnosis, including whether a myopathy was present, was determined for each patient with elevated aldolase.

Results:

489 patients had aldolase measured for the first time during the study period. 67 (13.7%) instances of elevated aldolase were noted. Of the 67 patients with elevated aldolase, 46 had elevated CK and 21 had normal CK. Of the 46 patients with elevated aldolase/elevated CK, 22 had a confirmed diagnosis of myopathy. Of the 21 patients with elevated aldolase/normal CK, none were confirmed to have a myopathy. Overall, there was a significant difference in frequency of confirmed myopathy in patients with elevated aldolase/normal CK and patients with elevated aldolase/elevated CK (P = 0.0001).

Conclusions:

Clinicians may check an aldolase level in an effort to better recognize myopathies. This study, however, demonstrates that the frequency of an elevated aldolase level in a patient with a normal CK level is low. Further, no patients with an isolated elevated aldolase in the setting of normal CK were confirmed to have a myopathy. Overall, checking a serum aldolase level is unlikely to aid in the diagnosis of myopathies in patients with normal CK and the use of the test should be reconsidered.