Aldolase Dx

Synonyms: Fructose biphosphate aldolase

CPT Code:  82085

Description: Aldolase is an enzyme that is elevated in some forms of muscle disease. Aldolase can be found in many tissues including skeletal muscle, liver, erythrocytes, and brain.

Method: Aldolase determinations are not routine in most laboratories. Several automated methods have been used including ultraviolet and coupled enzymatic determinations. Serum should be collected in a red-top tube.

Normal Values: Reference values are age related and may vary among laboratories. Newborns may have values as high as four times the adult value. Adult values usually range from 1.0 to 7.5 U/L. New borns age 0-2 years are usually < 16 U/L.

Increased in: Levels are increased in muscle disease – polymyositis, dermatomyositis, inclusion body myositis, eosinophilia-myalgia syndrome, progressive Duchenne muscular dystrophy, limb-girdle and facioscapulohumeral muscular dystrophy and muscle damage induced by infection (e.g., trichinosis, toxoplasmosis) or drug toxicity (e.g., cocaine). Levels are also elevated in hepatitis (hepatitis B and C) but not cirrhosis or biliary obstruction. Aldolase may also be elevated in autoinflammatory syndromes (TRAPs, FMF), systemic JIA, adult-onset Still’s disease, pancreatitis, myocardial infarction, delirium tremens, gangrene, myelogenous leukemia, renal cell carcinoma, eosinophilic fasciitis, measles, malignant hyperthermia, muscle trauma and strenuous exercise.

Confounding Factors: Erythrocytes contain aldolase, which thus may be falsely elevated with hemolysis. Aldolase values are proportional to muscle mass and may decline with muscle wasting.

Indications: Aldolase determinations are useful in evaluating patients with muscle disease, especially when wasting or weakness is present. Aldolase is less sensitive than creatinine phosphokinase (CPK) in evaluating muscle disease but is nonetheless complementary. A minority of myositis patients will have normal CPK values but elevated aldolase levels.  Both CPK and aldolase should be assessed when evaluating a potential myopathy. With the inflammatory myopathies, autoinflammatory disorders (including Still’s disease) and hepatitis, serial aldolase is useful in monitoring severity or response to therapy.

Cost: $30–48.