, Volume 15, Issue 4, pp 915–927 | Cite as

Myopathies Related to Glycogen Metabolism Disorders

  • Mark A. TarnopolskyEmail author


Most of the glycogen metabolism disorders that affect skeletal muscle involve enzymes in glycogenolysis (myophosphorylase (PYGM), glycogen debranching enzyme (AGL), phosphorylase b kinase (PHKB)) and glycolysis (phosphofructokinase (PFK), phosphoglycerate mutase (PGAM2), aldolase A (ALDOA), β-enolase (ENO3)); however, 3 involve glycogen synthesis (glycogenin-1 (GYG1), glycogen synthase (GSE), and branching enzyme (GBE1)). Many present with exercise-induced cramps and rhabdomyolysis with higher-intensity exercise (i.e., PYGM, PFK, PGAM2), yet others present with muscle atrophy and weakness (GYG1, AGL, GBE1). A failure of serum lactate to rise with exercise with an exaggerated ammonia response is a common, but not invariant, finding. The serum creatine kinase (CK) is often elevated in the myopathic forms and in PYGM deficiency, but can be normal and increase only with rhabdomyolysis (PGAM2, PFK, ENO3). Therapy for glycogen storage diseases that result in exercise-induced symptoms includes lifestyle adaptation and carefully titrated exercise. Immediate pre-exercise carbohydrate improves symptoms in the glycogenolytic defects (i.e., PYGM), but can exacerbate symptoms in glycolytic defects (i.e., PFK). Creatine monohydrate in low dose may provide a mild benefit in PYGM mutations.

Key Words

Glycolysis glycogenosis forearm exercise test myogenic hyperuricemia glycogenolytic 



I would like to thank Mr. Gordon Reid and Giant Tiger stores for the kind donations for the Giant Tiger Metabolic Testing facility and research into McArdle disease. The Canadian Institute for Health Research (CIHR) has supported Dr. Tarnopolsky’s work evaluating therapies for metabolic muscle disorders.

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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2018

Authors and Affiliations

  1. 1.Division of Neuromuscular & Neurometabolic Disorders, Departments of Pediatrics and MedicineMcMaster UniversityHamiltonCanada

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