Metabolic myopathies in adulthood. Features and clues for diagnosis

Metabolic myopathies are due to deficiencies of energy production involving glycogen, lipid, or mitochondrial metabolism. Deficiency of sarcoplasmic calcium-ATPase is at the origin of Brody's syndrome. Patients may present with exercise intolerance, myoglobinuria or progressive muscle weakness. The first step of diagnosis relies on the performance of in vivo metabolism investigations: forearm or bicycle ergometer exercise tests, phosphorus nuclear magnetic resonance spectroscopy. A few enzymatic defects may be directly measured on blood sampling, but muscle biopsy is necessary in most cases in order to precise the etiology of the metabolic defect through enzymatic assays. We present a description of the main metabolic myopathies with an overview of clinical and laboratory evaluation leading to diagnosis.