Emotional distress induced rhabdomyolysis in an individual with carnitine palmitolytransferase deficiency

A 48-year-old male patient with underlying CPT II enzyme deficiency is desc ribed. Emotional stress appeared to precipitate recurrent myalgias, rhabdom yolysis and reversible renal impairment over a 40-year period. Our search o f the English literature indicates this to be the first time that the emoti onal stress has been documented to precipitate the CPT II syndrome. Althoug h the pathogenesis of this syndrome has yet to be established, existing kno wledge is briefly reviewed and the likely metabolic and neuroendocrine mech anisms which link emotional stress to muscle metabolism are examined. These mechanisms influence the extent of lipolysis or glycolysis that occurs dur ing the process of muscle ATP generation. It is suggested that neuroendocri ne and other stress related changes which favour lipolysis over glycolysis adversely effect muscle energy metabolism in patients whose mitochondria ar e deficient in CPT II enzyme. Possible treatment strategies are those that favour glycolysis over fatty a cid metabolism and include a variety of ways of modulating sympathetic and parasympathetic tone. The use of carbohydrate supplementation P-blockers an d anxiolytic agents is discussed.