From the Guidelines
Isolated aldolase elevation is a nonspecific finding that requires further investigation to determine its underlying cause, and testing for blood levels of creatine phosphokinase (CK) or other muscle-related enzymes can confirm the nonhepatic origin of this event. When evaluating an isolated aldolase elevation, it is essential to consider common causes such as muscle disorders (myopathies, muscular dystrophies), liver diseases, or recent strenuous exercise 1. A comprehensive workup should include additional muscle enzymes like CK, liver function tests, and a thorough clinical history focusing on muscle symptoms, medication use, and recent physical activity.
Some key points to consider in the evaluation of isolated aldolase elevation include:
- Muscle injury from intensive exercising, such as weight lifting, can lead to an acute elevation in AST and ALT, which can be mistaken for acute DILI 1
- Patients receiving statins as concomitant therapy for dyslipidemia may also have elevated ALT and AST due to statin-related muscle injury 1
- Testing for blood levels of CK, aldolase, or other muscle-related enzymes can confirm the nonhepatic origin of this event 1
- A liver biopsy may be helpful in ruling out idiopathic AIH, especially in patients with concomitant hypergammaglobulinemia or other clinical features suggesting AIH 1
If the elevation is significant (typically >2 times the upper limit of normal) or persistent, referral to a specialist (rheumatologist, neurologist, or hepatologist) is recommended. Patients should be asked about muscle pain, weakness, dark urine, or other symptoms that might suggest specific diagnoses. While isolated aldolase elevation without other abnormal findings may occasionally be benign, it should not be dismissed without appropriate evaluation, as it could be an early indicator of developing pathology. Treatment depends entirely on the underlying cause rather than the enzyme elevation itself, which is merely a diagnostic marker.
From the Research
Significance of Isolated Aldolase Elevation
- Isolated aldolase elevation can be a potential biomarker of damaged early regenerating muscle cells in myositis patients 2
- It may reflect preferential immune-mediated damage of early regenerative cells 2
- Elevated serum aldolase A levels can occur in the absence of elevated creatine kinase M (CK) levels in a subset of myositis patients 2
- Isolated aldolase elevation can also be associated with fever-induced recurrent rhabdomyolysis without hemolytic anemia, particularly in cases of aldolase A deficiency 3
- In eosinophilic fasciitis, elevated aldolase levels can be a useful diagnostic and monitoring tool, particularly when other laboratory abnormalities are transient or absent 4
- The use of serum aldolase in conjunction with creatine kinase can provide a more comprehensive understanding of muscle disease, particularly in cases where CK levels are within the reference range 5
Clinical Implications
- Isolated aldolase elevation can be an important indicator of muscle damage or disease, even in the absence of other laboratory abnormalities 2, 4
- The measurement of aldolase levels can be a useful adjunct to other diagnostic tests, such as creatine kinase, in the diagnosis and monitoring of muscle disease 5
- Elevated aldolase levels can be associated with a range of clinical conditions, including myositis, rhabdomyolysis, and eosinophilic fasciitis 2, 3, 4