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Glycogen storage disease

A glycogen storage disease (GSD, also glycogenosis and dextrinosis) is a metabolic disorder caused by a deficiency of an enzyme or transport protein affecting glycogen synthesis, glycogen breakdown, or glucose breakdown, typically in muscles and/or liver cells.[1]

Glycogen storage disease
Other namesGlycogenosis, dextrinosis
Glycogen
SpecialtyEndocrinology 

GSD has two classes of cause: genetic and environmental. Genetic GSD is caused by any inborn error of carbohydrate metabolism (genetically defective enzymes or transport proteins) involved in these processes. In livestock, environmental GSD is caused by intoxication with the alkaloid castanospermine.[2]

However, not every inborn error of carbohydrate metabolism has been assigned a GSD number, even if it is known to affect the muscles or liver. For example, phosphoglycerate kinase deficiency (gene PGK1) has a myopathic form.

Also, Fanconi-Bickel syndrome (gene SLC2A2) and Danon disease (gene LAMP2) were declassed as GSDs due to being defects of transport proteins rather than enzymes; however, GSD-1 subtypes b, c, and d are due to defects of transport proteins (genes SLC37A4, SLC17A3) yet are still considered GSDs.

Phosphoglucomutase deficiency (gene PGM1) was declassed as a GSD due to it also affecting the formation of N-glycans; however, as it affects both glycogenolysis and glycosylation, it has been suggested that it should re-designated as GSD-XIV.[3]

(See inborn errors of carbohydrate metabolism for a full list of inherited diseases that affect glycogen synthesis, glycogen breakdown, or glucose breakdown.)

Types edit

Type
(Eponym)
Enzyme deficiency
(Gene[4])
Incidence (births) Hypo-
glycemia
?
Hepato-
megaly
?
Hyper-
lipidemia
?
Muscle symptoms Development/ prognosis Other symptoms
GSD 0

(Lewis' disease)[5]

Glycogen synthase
(Muscle GYS1 / Liver GYS2)
1 in 20,000–25,000[6] Liver 0a: Yes

Muscle 0b: No

No No (Muscle 0b) Glycogen deficiency in muscle fibres. Type I muscle fibre predominance. Exercise-induced, muscle fatigue, myalgia, fainting.[7][8] Occasional muscle cramping [citation needed] (Liver 0a) Growth failure in some cases.[9]

(Muscle 0b) Risk of sudden death in childhood due to cardiac arrest.[7]

(Liver 0a) Epilepsy[9]

(Muscle 0b) Rarely epilepsy, tonic-clonic seizures.[7] Arrhythmia, long QT syndrome.[8]

GSD I / GSD 1
(von Gierke's disease)
Glucose-6-phosphatase / Glucose-6-phosphate translocase
(G6PC / SLC37A4 /SLC17A3)
1 in 50,000 – 100,000[10][11][12] Yes Yes Yes None Growth failure Lactic acidosis, hyperuricemia
GSD II / GSD 2
(Pompe disease, formerly GSD-IIa)
Danon disease (formerly GSD-IIb)
Acid alpha-glucosidase

(GAA)


Lysosome-associated membrane protein 2
(LAMP2)
Pompe disease is 1 in 13,000.[13] No Yes No Muscle weakness, exercise intolerance, abnormal lysosomal glycogen accumulation in muscle biopsy. Late-onset Pompe may have a pseudoathletic appearance of hypertrophic calf muscles.[14]

The symptoms of both Pompe and Danon diseases are very similar due to a defect in lysosomes. However, in Danon disease, some show abnormal glycogen accumulation, but not all.[15]

Progressive proximal skeletal muscle weakness with varied timeline to threshold of functional limitation (early childhood to adulthood). Approximately 15% of the Pompe population is classified as infantile Pompe which is typically deadly within the first year if untreated. Heart failure (infantile), respiratory difficulty (due to muscle weakness)
GSD III / GSD 3
(Cori's disease or Forbes' disease)
Glycogen debranching enzyme
(AGL)
1 in 100,000 Yes Yes Yes Myopathy. May have a pseudoathletic appearance of hypertrophic muscles.[16] Failure to thrive[17]

myogenic hyperuricemia[18]

GSD IV / GSD 4
(Andersen's disease)
Glycogen branching enzyme
(GBE1)
1 in 500,000[19] No Yes,
also
cirrhosis
No Myopathy and dilated cardiomyopathy Failure to thrive, death at age ~5 years
GSD V / GSD 5
(McArdle's disease)
Muscle glycogen phosphorylase
(PYGM)
1 in 100,000 – 500,000[20][19] No No No Exercise-induced muscle fatigue and cramps. Rhabdomyolysis possible. May have a pseudoathletic appearance of hypertrophic calf muscles.[21] Renal failure by myoglobinuria, second wind phenomenon, inappropriate rapid heart rate (sinus tachycardia) response to exercise, myogenic hyperuricemia[18]
GSD VI / GSD 6
(Hers' disease)
Liver glycogen phosphorylase
(PYGL)
1 in 65,000 – 85,000[22] Yes Yes Yes[23] None initially benign, developmental delay follows.
GSD VII / GSD 7
(Tarui's disease)
Muscle phosphofructokinase
(PFKM)
1 in 1,000,000[24] No No No Exercise-induced muscle cramps and weakness developmental delay In some haemolytic anaemia,

myogenic hyperuricemia[18]

GSD IX / GSD 9 Phosphorylase kinase
(PHKA2 / PHKB / PHKG2 / PHKA1)
? Yes Yes Yes IXd Exercise-induced muscle cramps, stiffness, weakness (fatigue), and pain.[25] Liver type: Delayed motor development, Developmental delay
GSD X / GSD 10 Muscle Phosphoglycerate mutase(PGAM2) ? ? ? ? Exercise-induced muscle cramps and weakness[26] Myoglobinuria[27]
GSD XI / GSD 11 Muscle lactate dehydrogenase
(LDHA)
? ? ? ?

Exercise-induced muscle cramps, stiffness, pain.[28]

Fanconi-Bickel syndrome
formerly GSD XI / GSD 11, no longer considered a GSD
Glucose transporter
(GLUT2)
? Yes

Yes

No None
GSD XII / GSD 12
(Aldolase A deficiency)
Aldolase A
(ALDOA)
? No In some No Exercise intolerance, cramps. In some Rhabdomyolysis. Hemolytic anemia and other symptoms
GSD XIII / GSD 13 β-enolase
(ENO3)
? No ? No Exercise intolerance, cramps Increasing intensity of myalgias over decades[29] Serum CK: Episodic elevations; Reduced with rest[29]
CDG1T (formally GSD XIV / GSD 14) Phosphoglucomutase-1(PGM1) ? Episodic ? No Two forms: exclusively myopathic and multi-system (including muscles).[30]

Myopathy (including exercise-related fatigue, exercise intolerance, muscle weakness). Muscle biopsy shows glycogen accumulation.[31]

Short stature, some have developmental delay, and rarely delayed puberty.[31] Highly variable phenotype and severity. Commonly elevated serum CK, abnormal serum transferrin (loss of complete N-glycans), short stature, cleft palate, bifid uvula, and hepatopathy.[31]

Second Wind phenomenon in some[32] but not all[3]

GSD XV / GSD 15 Glycogenin-1
(GYG1)
Rare[33] No No No Muscle atrophy, exercise intolerance, muscle biopsy shows abnormal glycogen depletion and marked proliferation of slow-twitch (type 1/oxidative) muscle fibres and mitochondrial proliferation. Slowly progressive weakness over decades Arrhythmia, biopsy of heart showed abnormal glycogen deposits (different from polyglucosan bodies) in cardiomyocytes.[34]

Remarks:

  • Some GSDs have different forms, e.g. infantile, juvenile, adult (late-onset).
  • Some GSDs have different subtypes, e.g. GSD1a / GSD1b, GSD9A1 / GSD9A2 / GSD9B / GSD9C / GSD9D.[4]
  • GSD type 0: Although glycogen synthase deficiency does not result in storage of extra glycogen in the liver, it is classified with the GSDs as type 0 because it is another defect of glycogen storage and can cause similar problems.
  • GSD type VIII (GSD 8): In the past, liver phosphorylase-b kinase deficiency was considered a distinct condition,[35] however it has been classified with GSD type VI[22] and GSD IXa1;[36] it has been described as X-linked recessive inherited.[37] GSD IX has become the dominant classification for this disease, grouped with the other isoenzymes of phosphorylase-b kinase deficiency.[38]
  • GSD type XI (GSD 11): Fanconi-Bickel syndrome (GLUT2 deficiency), hepatorenal glycogenosis with renal Fanconi syndrome, no longer considered a glycogen storage disease, but a defect of glucose transport.[4] The designation of GSD type XI (GSD 11) has been repurposed for muscle lactate dehydrogenase deficiency (LDHA).
  • GSD type XIV (GSD 14): No longer classed as a GSD, but as a congenital disorder of glycosylation type 1T (CDG1T), affects the phosphoglucomutase enzyme (gene PGM1).[4] Phosphoglucomutase 1 deficiency is both a glycogenosis and a congenital disorder of glycosylation.[39] Individuals with the disease have both a glycolytic block as muscle glycogen cannot be broken down, as well as abnormal serum transferrin (loss of complete N-glycans).[39] As it affects glycogenolysis, it has been suggested that it should re-designated as GSD-XIV.[3]
  • Lafora disease is considered a complex neurodegenerative disease and also a glycogen metabolism disorder.[40]
  • Polyglucosan storage myopathies are associated with defective glycogen metabolism[41]
  • (Not McArdle disease, same gene but different symptoms) Myophosphorylase-a activity impaired: Autosomal dominant mutation on PYGM gene. AMP-independent myophosphorylase activity impaired, whereas the AMP-dependent activity was preserved. No exercise intolerance. Adult-onset muscle weakness. Accumulation of the intermediate filament desmin in the myofibers of the patients.[42][43] Myophosphorylase comes in two forms: form 'a' is phosphorylated by phosphorylase kinase, form 'b' is not phosphorylated. Both forms have two conformational states: active (R or relaxed) and inactive (T or tense). When either form 'a' or 'b' are in the active state, then the enzyme converts glycogen into glucose-1-phosphate. Myophosphorylase-b is allosterically activated by AMP being in larger concentration than ATP and/or glucose-6-phosphate. (See Glycogen phosphorylase§Regulation).
  • Unknown glycogenosis related to dystrophy gene deletion: patient has a previously undescribed myopathy associated with both Becker muscular dystrophy and a glycogen storage disorder of unknown aetiology.[44]

Diagnosis edit

 
Micrograph of glycogen storage disease with histologic features consistent with Cori disease. Liver biopsy. H&E stain.

Methods to diagnose glycogen storage diseases include history and physical examination for associated symptoms, blood tests for associated metabolic disturbances, and genetic testing for suspected mutations.[16][45] It may also include a non-ischemic forearm test, exercise stress test, or 12-minute walk test (12MWT).[45] Advancements in genetic testing are slowly diminishing the need for biopsy; however, in the event of a VUS and inconclusive exercise tests, a biopsy would then be necessary to confirm diagnosis.[45]

Differential diagnoses edit

Muscle edit

Glycogen storage diseases that involve skeletal muscle typically have exercise-induced (dynamic) symptoms, such as muscle fatigue, rather than fixed weakness (static) symptoms.[46] Differential diagnoses for glycogen storage diseases that involve fixed muscle weakness, particularly of the proximal muscles, would be an inflammatory myopathy or a limb-girdle muscular dystrophy.[46]

For those with exercise intolerance and/or proximal muscle weakness, the endocrinopathies should be considered.[47][48][49] The timing of the symptoms of exercise intolerance, such as muscle fatigue and cramping, is important in order to help distinguish it from other metabolic myopathies such as fatty acid metabolism disorders.[50]

Problems originating within the circulatory system, rather than the muscle itself, can produce exercise-induced muscle fatigue, pain and cramping that alleviates with rest, resulting from inadequate blood flow (ischemia) to the muscles. Ischemia that often produces symptoms in the leg muscles includes intermittent claudication, popliteal artery entrapment syndrome, and chronic venous insufficiency.

Diseases disrupting the neuromuscular junction can cause abnormal muscle fatigue, such as myasthenia gravis, an auto-immune disease.[51] Similar, are Lambert–Eaton myasthenic syndrome (auto-immune) and the congenital myasthenic syndromes (genetic).

Diseases can disrupt glycogen metabolism secondary to the primary disease. Abnormal thyroid function—hypo- and hyperthyroidism—can manifest as myopathy with symptoms of exercise-induced muscle fatigue, cramping, muscle pain and may include proximal weakness or muscle hypertrophy (particularly of the calves).[52][48]Hypothyroidism up-regulates glycogen synthesis and down-regulates glycogenolysis and glycolysis; conversely, hyperthyroidism does the reverse, up-regulating glycogenolysis and glycolysis while down-regulating glycogen synthesis.[53][54][55][48][56]

Prolonged hypo- and hyperthyroid myopathy leads to atrophy of type II (fast-twitch/glycolytic) muscle fibres, and a predominance of type I (slow-twitch/oxidative) muscle fibres.[54][48][49] Muscle biopsy shows abnormal muscle glycogen: high accumulation in hypothyroidism and low accumulation in hyperthyroidism.[56][53][54] Hypothyroid myopathy includes Kocher-Debre-Semelaigne syndrome (childhood-onset), Hoffman syndrome (adult-onset), myasthenic syndrome, and atrophic form.[56]

In patients with increased growth hormone, muscle biopsy includes, among other features, excess glycogen deposition.[57]

It is interesting to note, in comparison to hypothyroid myopathy, that McArdle disease (GSD-V), which is by far the most commonly diagnosed of the muscle GSDs and therefore the most studied,[58][45][59] has as its second highest comorbidity endocrine disease (chiefly hypothyroidism)[60][45] and that some patients with McArdle disease also have hypertrophy of the calf muscles.[21] Late-onset Pompe disease (GSD-II) also has calf hypertrophy and hyopthyroidism as comorbidities.[14][61][62]

Poor diet and malabsorption diseases (such as celiac disease) may lead to malnutrition of essential vitamins necessary for glycogen metabolism within the muscle cells. Malnutrition typically presents with systemic symptoms, but in rare instances can be limited to myopathy.[63] Vitamin D deficiency myopathy (also known as osteomalic myopathy due to the interplay between vitamin D and calcium) results in muscle weakness, predominantly of the proximal muscles; with muscle biopsy showing abnormal glycogen accumulation, atrophy of type II (fast-twitch/glycolytic) muscle fibres, and diminished calcium uptake by the sarcoplasmic reticulum (needed for muscle contraction).[64][65][66] Although Vitamin D deficiency myopathy typically includes muscle atrophy,[64] rarely calf muscle hypertrophy has been reported.[67][68]

Exercise-induced, electrically silent, muscle cramping and stiffness (transient muscle contractures or "pseudomyotonia") are seen not only in GSD types V, VII, IXd, X, XI, XII, and XIII, but also in Brody disease, Rippling muscle disease types 1 and 2, and CAV3-related hyperCKemia (Elevated serum creatine phosphokinase).[26] Unlike the other myopathies, in Brody disease the muscle cramping is painless.[69][70] Like GSD types II, III, and V, a pseudoathletic appearance of muscle hypertrophy is also seen in some with Brody disease and Rippling muscle disease.[69][71][72]

Erythrocyte lactate transporter defect (formerly Lactate transporter defect, myopathy due to) also includes exercise-induced, electrically silent, painful muscle cramping and transient contractures; as well as exercise-induced muscle fatigue.[26][73] EMG and muscle biopsy is normal however, as the defect is not in the muscle but in the red blood cells that should clear lactate buildup from exercising muscles.[73]

Although most muscular dystrophies have fixed muscle weakness rather than exercise-induced muscle fatigue and/or cramping, there are a few exceptions. Limb–girdle muscular dystrophy autosomal recessive 23 (LGMD R23) has calf hypertrophy and exercise-induced cramping.[74] Myofibrillar myopathy 10 (MFM10) has exercise-induced muscle fatigue, cramping and stiffness, with hypertrophic neck and shoulder girdle muscles.[75] LGMD R28 has calf hypertrophy and exercise-induced muscle fatigue and pain.[76] LGMD R8 has calf pseudohypertrophy and exercise-induced weakness (fatigue) and pain.[77] LGMD R15 (a.k.a MDDGC3) has muscle hypertrophy, proximal muscle weakness, and muscle fatigue.[78]

DMD-related myopathies of Duchenne and Becker muscular dystrophy are known for fixed muscle weakness and pseudohypertrophic calf muscles, but they also have secondary muscular mitochondrial impairment causing low ATP production; as well as decreasing type II (fast-twitch/glycolytic) muscle fibres, producing a predominance of type I (slow-twitch/oxidative) muscle fibres.[79] DMD-related childhood-onset milder phenotypes present with exercise-induced muscle cramping, stiffness, pain, fatigue, and elevated CK.[80] Becker muscular dystrophy has adult-onset exercise-induced muscle cramping, pain, and elevated CK.[81]

Tubular aggregate myopathy (TAM) types 1 and 2 has exercise-induced muscle pain, fatigue, stiffness, with proximal muscle weakness and calf muscle pseudohypertrophy. TAM1 has cramping at rest, while TAM2 has cramping during exercise.[82][83][84][85] Stormorken syndrome includes the symptoms of TAM, but is a more severe presentation including short stature and other abnormalities.[83] Satoyoshi syndrome has exercise-induced painful muscle cramps, muscle hypertrophy, and short stature.[86] Dimethylglycine dehydrogenase deficiency has muscle fatigue, elevated CK, and fishy body odour.[87] Myopathy with myalgia, increased serum creatine kinase, with or without episodic rhabdomyolysis (MMCKR) has exercise-induced muscle cramps, pain, and fatigue; with some exhibiting proximal muscle weakness.[88]

Liver edit

(help wikipedia by contributing to this subsection)

Treatment edit

Treatment is dependent on the type of glycogen storage disease. Von Gierke disease (GSD-I) is typically treated with frequent small meals of carbohydrates and cornstarch, called modified cornstarch therapy, to prevent low blood sugar, while other treatments may include allopurinol and human granulocyte colony stimulating factor.[89]

Cori/Forbes disease (GSD-III) treatment may use modified cornstarch therapy, a high protein diet with a preference to complex carbohydrates. However, unlike GSD-I, gluconeogenesis is functional, so simple sugars (sucrose, fructose, and lactose) are not prohibited.[16]

A ketogenic diet has demonstrated beneficial for McArdle disease (GSD-V) as ketones readily convert to acetyl CoA for oxidative phosphorylation, whereas free fatty acids take a few minutes to convert into acetyl CoA.[90][91]

For phosphoglucomutase deficiency (formerly GSD-XIV), D-galactose supplements and exercise training has shown favourable improvement of signs and symptoms.[30] In terms of exercise training, some patients with phosphoglucomutase deficiency also experience "second wind."[30][32]

For McArdle disease (GSD-V), regular aerobic exercise utilizing "second wind" to enable the muscles to become aerobically conditioned, as well as anaerobic exercise (strength training) that follows the activity adaptations so as not to cause muscle injury, helps to improve exercise intolerance symptoms and maintain overall health.[45][59][92][93] Studies have shown that regular low-moderate aerobic exercise increases peak power output, increases peak oxygen uptake (VO2peak), lowers heart rate, and lowers serum CK in individuals with McArdle disease.[92][93]

Regardless of whether the patient experiences symptoms of muscle pain, muscle fatigue, or cramping, the phenomenon of second wind having been achieved is demonstrable by the sign of an increased heart rate dropping while maintaining the same speed on the treadmill.[93] Inactive patients experienced second wind, demonstrated through relief of typical symptoms and the sign of an increased heart rate dropping, while performing low-moderate aerobic exercise (walking or brisk walking).[93]

Conversely, patients that were regularly active did not experience the typical symptoms during low-moderate aerobic exercise (walking or brisk walking), but still demonstrated second wind by the sign of an increased heart rate dropping.[93][94] For the regularly active patients, it took more strenuous exercise (very brisk walking/jogging or bicycling) for them to experience both the typical symptoms and relief thereof, along with the sign of an increased heart rate dropping, demonstrating second wind.[93][94][95]

In young children (<10 years old) with McArdle disease (GSD-V), it may be more difficult to detect the second wind phenomenon. They may show a normal heart rate, with normal or above normal peak cardio-respiratory capacity (VO2max).[45][96] That said, patients with McArdle disease typically experience symptoms of exercise intolerance before the age of 10 years,[45] with the median symptomatic age of 3 years.[58][97]

Tarui disease (GSD-VII) patients do not experience the "second wind" phenomenon; instead are said to be "out-of-wind."[45][59][98] However, they can achieve sub-maximal benefit from lipid metabolism of free fatty acids during aerobic activity following a warm-up.[45]

Epidemiology edit

 
Relative incidences of the main types of glycogen storage disease.

Overall, according to a study in British Columbia, approximately 2.3 children per 100,000 births (1 in 43,000) have some form of glycogen storage disease.[99] In the United States, they are estimated to occur in 1 per 20,000–25,000 births.[10] Dutch incidence rate is estimated to be 1 per 40,000 births. While a Mexican incidence showed 6.78:1000 male newborns.[12][100]

Within the category of muscle glycogenoses (muscle GSDs), McArdle disease (GSD-V) is by far the most commonly diagnosed.[58]

See also edit

References edit

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  2. ^ Stegelmeier BL, Molyneux RJ, Elbein AD, James LF (May 1995). "The lesions of locoweed (Astragalus mollissimus), swainsonine, and castanospermine in rats". Veterinary Pathology. 32 (3): 289–98. doi:10.1177/030098589503200311. PMID 7604496. S2CID 45016726.
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External links edit

  • AGSD. - Association for Glycogen Storage Disease. A US-based non-profit, parent and patient oriented support group dedicated to promoting the best interest of all the different types of glycogen storage disease.
  • AGSD-UK - Association for Glycogen Storage Disease (UK). A UK-based charity which helps individuals and families affected by Glycogen Storage Disease by putting people in contact, providing information and support, publishing a magazine and holding conferences, workshops, courses and family events.
  • IamGSD - International Association for Muscle Glycogen Storage Disease. A non-profit, patient-led international group encouraging efforts by research and medical professionals, national support groups and individual patients worldwide.
  • IPA - International Pompe Association. (Pompe Disease is also known as GSD-II). A non-profit, federation of Pompe disease patient's groups world-wide. It seeks to coordinate activities and share experience and knowledge between different groups.
  • EUROMAC - EUROMAC is a European registry of patients affected by McArdle Disease and other rare neuromuscular glycogenoses.
  • CoRDS - Coordination of Rare Diseases at Sanford (CoRDS) is a centralized international patient registry for all rare diseases. They work with patient advocacy groups, including IamGSD, individuals and researchers.
  • CORD - Canadian Organization for Rare Disorders (CORD) is a Canadian national network for organizations representing all those with rare disorders. CORD provides a strong common voice to advocate for health policy and a healthcare system that works for those with rare disorders.
  • NORD - National Organization for Rare Disorders (NORD) is an American national non-profit patient advocacy organization that is dedicated to individuals with rare diseases and the organizations that serve them.
  • EURODIS - Rare Diseases Europe (EURODIS) is a unique, non-profit alliance of over 700 rare disease patient organizations across Europe that work together to improve the lives of the 30 million people living with a rare disease in Europe.

glycogen, storage, disease, glycogen, storage, disease, also, glycogenosis, dextrinosis, metabolic, disorder, caused, deficiency, enzyme, transport, protein, affecting, glycogen, synthesis, glycogen, breakdown, glucose, breakdown, typically, muscles, liver, ce. A glycogen storage disease GSD also glycogenosis and dextrinosis is a metabolic disorder caused by a deficiency of an enzyme or transport protein affecting glycogen synthesis glycogen breakdown or glucose breakdown typically in muscles and or liver cells 1 Glycogen storage diseaseOther namesGlycogenosis dextrinosisGlycogenSpecialtyEndocrinology GSD has two classes of cause genetic and environmental Genetic GSD is caused by any inborn error of carbohydrate metabolism genetically defective enzymes or transport proteins involved in these processes In livestock environmental GSD is caused by intoxication with the alkaloid castanospermine 2 However not every inborn error of carbohydrate metabolism has been assigned a GSD number even if it is known to affect the muscles or liver For example phosphoglycerate kinase deficiency gene PGK1 has a myopathic form Also Fanconi Bickel syndrome gene SLC2A2 and Danon disease gene LAMP2 were declassed as GSDs due to being defects of transport proteins rather than enzymes however GSD 1 subtypes b c and d are due to defects of transport proteins genes SLC37A4 SLC17A3 yet are still considered GSDs Phosphoglucomutase deficiency gene PGM1 was declassed as a GSD due to it also affecting the formation of N glycans however as it affects both glycogenolysis and glycosylation it has been suggested that it should re designated as GSD XIV 3 See inborn errors of carbohydrate metabolism for a full list of inherited diseases that affect glycogen synthesis glycogen breakdown or glucose breakdown Contents 1 Types 2 Diagnosis 3 Differential diagnoses 3 1 Muscle 3 2 Liver 4 Treatment 5 Epidemiology 6 See also 7 References 8 External linksTypes editType Eponym Enzyme deficiency Gene 4 Incidence births Hypo glycemia Hepato megaly Hyper lipidemia Muscle symptoms Development prognosis Other symptomsGSD 0 Lewis disease 5 Glycogen synthase Muscle GYS1 Liver GYS2 1 in 20 000 25 000 6 Liver 0a Yes Muscle 0b No No No Muscle 0b Glycogen deficiency in muscle fibres Type I muscle fibre predominance Exercise induced muscle fatigue myalgia fainting 7 8 Occasional muscle cramping citation needed Liver 0a Growth failure in some cases 9 Muscle 0b Risk of sudden death in childhood due to cardiac arrest 7 Liver 0a Epilepsy 9 Muscle 0b Rarely epilepsy tonic clonic seizures 7 Arrhythmia long QT syndrome 8 GSD I GSD 1 von Gierke s disease Glucose 6 phosphatase Glucose 6 phosphate translocase G6PC SLC37A4 SLC17A3 1 in 50 000 100 000 10 11 12 Yes Yes Yes None Growth failure Lactic acidosis hyperuricemiaGSD II GSD 2 Pompe disease formerly GSD IIa Danon disease formerly GSD IIb Acid alpha glucosidase GAA Lysosome associated membrane protein 2 LAMP2 Pompe disease is 1 in 13 000 13 No Yes No Muscle weakness exercise intolerance abnormal lysosomal glycogen accumulation in muscle biopsy Late onset Pompe may have a pseudoathletic appearance of hypertrophic calf muscles 14 The symptoms of both Pompe and Danon diseases are very similar due to a defect in lysosomes However in Danon disease some show abnormal glycogen accumulation but not all 15 Progressive proximal skeletal muscle weakness with varied timeline to threshold of functional limitation early childhood to adulthood Approximately 15 of the Pompe population is classified as infantile Pompe which is typically deadly within the first year if untreated Heart failure infantile respiratory difficulty due to muscle weakness GSD III GSD 3 Cori s disease or Forbes disease Glycogen debranching enzyme AGL 1 in 100 000 Yes Yes Yes Myopathy May have a pseudoathletic appearance of hypertrophic muscles 16 Failure to thrive 17 myogenic hyperuricemia 18 GSD IV GSD 4 Andersen s disease Glycogen branching enzyme GBE1 1 in 500 000 19 No Yes also cirrhosis No Myopathy and dilated cardiomyopathy Failure to thrive death at age 5 yearsGSD V GSD 5 McArdle s disease Muscle glycogen phosphorylase PYGM 1 in 100 000 500 000 20 19 No No No Exercise induced muscle fatigue and cramps Rhabdomyolysis possible May have a pseudoathletic appearance of hypertrophic calf muscles 21 Renal failure by myoglobinuria second wind phenomenon inappropriate rapid heart rate sinus tachycardia response to exercise myogenic hyperuricemia 18 GSD VI GSD 6 Hers disease Liver glycogen phosphorylase PYGL 1 in 65 000 85 000 22 Yes Yes Yes 23 None initially benign developmental delay follows GSD VII GSD 7 Tarui s disease Muscle phosphofructokinase PFKM 1 in 1 000 000 24 No No No Exercise induced muscle cramps and weakness developmental delay In some haemolytic anaemia myogenic hyperuricemia 18 GSD IX GSD 9 Phosphorylase kinase PHKA2 PHKB PHKG2 PHKA1 Yes Yes Yes IXd Exercise induced muscle cramps stiffness weakness fatigue and pain 25 Liver type Delayed motor development Developmental delayGSD X GSD 10 Muscle Phosphoglycerate mutase PGAM2 Exercise induced muscle cramps and weakness 26 Myoglobinuria 27 GSD XI GSD 11 Muscle lactate dehydrogenase LDHA Exercise induced muscle cramps stiffness pain 28 Fanconi Bickel syndromeformerly GSD XI GSD 11 no longer considered a GSD Glucose transporter GLUT2 Yes Yes No NoneGSD XII GSD 12 Aldolase A deficiency Aldolase A ALDOA No In some No Exercise intolerance cramps In some Rhabdomyolysis Hemolytic anemia and other symptomsGSD XIII GSD 13 b enolase ENO3 No No Exercise intolerance cramps Increasing intensity of myalgias over decades 29 Serum CK Episodic elevations Reduced with rest 29 CDG1T formally GSD XIV GSD 14 Phosphoglucomutase 1 PGM1 Episodic No Two forms exclusively myopathic and multi system including muscles 30 Myopathy including exercise related fatigue exercise intolerance muscle weakness Muscle biopsy shows glycogen accumulation 31 Short stature some have developmental delay and rarely delayed puberty 31 Highly variable phenotype and severity Commonly elevated serum CK abnormal serum transferrin loss of complete N glycans short stature cleft palate bifid uvula and hepatopathy 31 Second Wind phenomenon in some 32 but not all 3 GSD XV GSD 15 Glycogenin 1 GYG1 Rare 33 No No No Muscle atrophy exercise intolerance muscle biopsy shows abnormal glycogen depletion and marked proliferation of slow twitch type 1 oxidative muscle fibres and mitochondrial proliferation Slowly progressive weakness over decades Arrhythmia biopsy of heart showed abnormal glycogen deposits different from polyglucosan bodies in cardiomyocytes 34 Remarks Some GSDs have different forms e g infantile juvenile adult late onset Some GSDs have different subtypes e g GSD1a GSD1b GSD9A1 GSD9A2 GSD9B GSD9C GSD9D 4 GSD type 0 Although glycogen synthase deficiency does not result in storage of extra glycogen in the liver it is classified with the GSDs as type 0 because it is another defect of glycogen storage and can cause similar problems GSD type VIII GSD 8 In the past liver phosphorylase b kinase deficiency was considered a distinct condition 35 however it has been classified with GSD type VI 22 and GSD IXa1 36 it has been described as X linked recessive inherited 37 GSD IX has become the dominant classification for this disease grouped with the other isoenzymes of phosphorylase b kinase deficiency 38 GSD type XI GSD 11 Fanconi Bickel syndrome GLUT2 deficiency hepatorenal glycogenosis with renal Fanconi syndrome no longer considered a glycogen storage disease but a defect of glucose transport 4 The designation of GSD type XI GSD 11 has been repurposed for muscle lactate dehydrogenase deficiency LDHA GSD type XIV GSD 14 No longer classed as a GSD but as a congenital disorder of glycosylation type 1T CDG1T affects the phosphoglucomutase enzyme gene PGM1 4 Phosphoglucomutase 1 deficiency is both a glycogenosis and a congenital disorder of glycosylation 39 Individuals with the disease have both a glycolytic block as muscle glycogen cannot be broken down as well as abnormal serum transferrin loss of complete N glycans 39 As it affects glycogenolysis it has been suggested that it should re designated as GSD XIV 3 Lafora disease is considered a complex neurodegenerative disease and also a glycogen metabolism disorder 40 Polyglucosan storage myopathies are associated with defective glycogen metabolism 41 Not McArdle disease same gene but different symptoms Myophosphorylase a activity impaired Autosomal dominant mutation on PYGM gene AMP independent myophosphorylase activity impaired whereas the AMP dependent activity was preserved No exercise intolerance Adult onset muscle weakness Accumulation of the intermediate filament desmin in the myofibers of the patients 42 43 Myophosphorylase comes in two forms form a is phosphorylated by phosphorylase kinase form b is not phosphorylated Both forms have two conformational states active R or relaxed and inactive T or tense When either form a or b are in the active state then the enzyme converts glycogen into glucose 1 phosphate Myophosphorylase b is allosterically activated by AMP being in larger concentration than ATP and or glucose 6 phosphate See Glycogen phosphorylase Regulation Unknown glycogenosis related to dystrophy gene deletion patient has a previously undescribed myopathy associated with both Becker muscular dystrophy and a glycogen storage disorder of unknown aetiology 44 Diagnosis edit nbsp Micrograph of glycogen storage disease with histologic features consistent with Cori disease Liver biopsy H amp E stain Methods to diagnose glycogen storage diseases include history and physical examination for associated symptoms blood tests for associated metabolic disturbances and genetic testing for suspected mutations 16 45 It may also include a non ischemic forearm test exercise stress test or 12 minute walk test 12MWT 45 Advancements in genetic testing are slowly diminishing the need for biopsy however in the event of a VUS and inconclusive exercise tests a biopsy would then be necessary to confirm diagnosis 45 Differential diagnoses editMuscle edit Glycogen storage diseases that involve skeletal muscle typically have exercise induced dynamic symptoms such as muscle fatigue rather than fixed weakness static symptoms 46 Differential diagnoses for glycogen storage diseases that involve fixed muscle weakness particularly of the proximal muscles would be an inflammatory myopathy or a limb girdle muscular dystrophy 46 For those with exercise intolerance and or proximal muscle weakness the endocrinopathies should be considered 47 48 49 The timing of the symptoms of exercise intolerance such as muscle fatigue and cramping is important in order to help distinguish it from other metabolic myopathies such as fatty acid metabolism disorders 50 Problems originating within the circulatory system rather than the muscle itself can produce exercise induced muscle fatigue pain and cramping that alleviates with rest resulting from inadequate blood flow ischemia to the muscles Ischemia that often produces symptoms in the leg muscles includes intermittent claudication popliteal artery entrapment syndrome and chronic venous insufficiency Diseases disrupting the neuromuscular junction can cause abnormal muscle fatigue such as myasthenia gravis an auto immune disease 51 Similar are Lambert Eaton myasthenic syndrome auto immune and the congenital myasthenic syndromes genetic Diseases can disrupt glycogen metabolism secondary to the primary disease Abnormal thyroid function hypo and hyperthyroidism can manifest as myopathy with symptoms of exercise induced muscle fatigue cramping muscle pain and may include proximal weakness or muscle hypertrophy particularly of the calves 52 48 Hypothyroidism up regulates glycogen synthesis and down regulates glycogenolysis and glycolysis conversely hyperthyroidism does the reverse up regulating glycogenolysis and glycolysis while down regulating glycogen synthesis 53 54 55 48 56 Prolonged hypo and hyperthyroid myopathy leads to atrophy of type II fast twitch glycolytic muscle fibres and a predominance of type I slow twitch oxidative muscle fibres 54 48 49 Muscle biopsy shows abnormal muscle glycogen high accumulation in hypothyroidism and low accumulation in hyperthyroidism 56 53 54 Hypothyroid myopathy includes Kocher Debre Semelaigne syndrome childhood onset Hoffman syndrome adult onset myasthenic syndrome and atrophic form 56 In patients with increased growth hormone muscle biopsy includes among other features excess glycogen deposition 57 It is interesting to note in comparison to hypothyroid myopathy that McArdle disease GSD V which is by far the most commonly diagnosed of the muscle GSDs and therefore the most studied 58 45 59 has as its second highest comorbidity endocrine disease chiefly hypothyroidism 60 45 and that some patients with McArdle disease also have hypertrophy of the calf muscles 21 Late onset Pompe disease GSD II also has calf hypertrophy and hyopthyroidism as comorbidities 14 61 62 Poor diet and malabsorption diseases such as celiac disease may lead to malnutrition of essential vitamins necessary for glycogen metabolism within the muscle cells Malnutrition typically presents with systemic symptoms but in rare instances can be limited to myopathy 63 Vitamin D deficiency myopathy also known as osteomalic myopathy due to the interplay between vitamin D and calcium results in muscle weakness predominantly of the proximal muscles with muscle biopsy showing abnormal glycogen accumulation atrophy of type II fast twitch glycolytic muscle fibres and diminished calcium uptake by the sarcoplasmic reticulum needed for muscle contraction 64 65 66 Although Vitamin D deficiency myopathy typically includes muscle atrophy 64 rarely calf muscle hypertrophy has been reported 67 68 Exercise induced electrically silent muscle cramping and stiffness transient muscle contractures or pseudomyotonia are seen not only in GSD types V VII IXd X XI XII and XIII but also in Brody disease Rippling muscle disease types 1 and 2 and CAV3 related hyperCKemia Elevated serum creatine phosphokinase 26 Unlike the other myopathies in Brody disease the muscle cramping is painless 69 70 Like GSD types II III and V a pseudoathletic appearance of muscle hypertrophy is also seen in some with Brody disease and Rippling muscle disease 69 71 72 Erythrocyte lactate transporter defect formerly Lactate transporter defect myopathy due to also includes exercise induced electrically silent painful muscle cramping and transient contractures as well as exercise induced muscle fatigue 26 73 EMG and muscle biopsy is normal however as the defect is not in the muscle but in the red blood cells that should clear lactate buildup from exercising muscles 73 Although most muscular dystrophies have fixed muscle weakness rather than exercise induced muscle fatigue and or cramping there are a few exceptions Limb girdle muscular dystrophy autosomal recessive 23 LGMD R23 has calf hypertrophy and exercise induced cramping 74 Myofibrillar myopathy 10 MFM10 has exercise induced muscle fatigue cramping and stiffness with hypertrophic neck and shoulder girdle muscles 75 LGMD R28 has calf hypertrophy and exercise induced muscle fatigue and pain 76 LGMD R8 has calf pseudohypertrophy and exercise induced weakness fatigue and pain 77 LGMD R15 a k a MDDGC3 has muscle hypertrophy proximal muscle weakness and muscle fatigue 78 DMD related myopathies of Duchenne and Becker muscular dystrophy are known for fixed muscle weakness and pseudohypertrophic calf muscles but they also have secondary muscular mitochondrial impairment causing low ATP production as well as decreasing type II fast twitch glycolytic muscle fibres producing a predominance of type I slow twitch oxidative muscle fibres 79 DMD related childhood onset milder phenotypes present with exercise induced muscle cramping stiffness pain fatigue and elevated CK 80 Becker muscular dystrophy has adult onset exercise induced muscle cramping pain and elevated CK 81 Tubular aggregate myopathy TAM types 1 and 2 has exercise induced muscle pain fatigue stiffness with proximal muscle weakness and calf muscle pseudohypertrophy TAM1 has cramping at rest while TAM2 has cramping during exercise 82 83 84 85 Stormorken syndrome includes the symptoms of TAM but is a more severe presentation including short stature and other abnormalities 83 Satoyoshi syndrome has exercise induced painful muscle cramps muscle hypertrophy and short stature 86 Dimethylglycine dehydrogenase deficiency has muscle fatigue elevated CK and fishy body odour 87 Myopathy with myalgia increased serum creatine kinase with or without episodic rhabdomyolysis MMCKR has exercise induced muscle cramps pain and fatigue with some exhibiting proximal muscle weakness 88 Liver edit help wikipedia by contributing to this subsection Treatment editTreatment is dependent on the type of glycogen storage disease Von Gierke disease GSD I is typically treated with frequent small meals of carbohydrates and cornstarch called modified cornstarch therapy to prevent low blood sugar while other treatments may include allopurinol and human granulocyte colony stimulating factor 89 Cori Forbes disease GSD III treatment may use modified cornstarch therapy a high protein diet with a preference to complex carbohydrates However unlike GSD I gluconeogenesis is functional so simple sugars sucrose fructose and lactose are not prohibited 16 A ketogenic diet has demonstrated beneficial for McArdle disease GSD V as ketones readily convert to acetyl CoA for oxidative phosphorylation whereas free fatty acids take a few minutes to convert into acetyl CoA 90 91 For phosphoglucomutase deficiency formerly GSD XIV D galactose supplements and exercise training has shown favourable improvement of signs and symptoms 30 In terms of exercise training some patients with phosphoglucomutase deficiency also experience second wind 30 32 For McArdle disease GSD V regular aerobic exercise utilizing second wind to enable the muscles to become aerobically conditioned as well as anaerobic exercise strength training that follows the activity adaptations so as not to cause muscle injury helps to improve exercise intolerance symptoms and maintain overall health 45 59 92 93 Studies have shown that regular low moderate aerobic exercise increases peak power output increases peak oxygen uptake VO2peak lowers heart rate and lowers serum CK in individuals with McArdle disease 92 93 Regardless of whether the patient experiences symptoms of muscle pain muscle fatigue or cramping the phenomenon of second wind having been achieved is demonstrable by the sign of an increased heart rate dropping while maintaining the same speed on the treadmill 93 Inactive patients experienced second wind demonstrated through relief of typical symptoms and the sign of an increased heart rate dropping while performing low moderate aerobic exercise walking or brisk walking 93 Conversely patients that were regularly active did not experience the typical symptoms during low moderate aerobic exercise walking or brisk walking but still demonstrated second wind by the sign of an increased heart rate dropping 93 94 For the regularly active patients it took more strenuous exercise very brisk walking jogging or bicycling for them to experience both the typical symptoms and relief thereof along with the sign of an increased heart rate dropping demonstrating second wind 93 94 95 In young children lt 10 years old with McArdle disease GSD V it may be more difficult to detect the second wind phenomenon They may show a normal heart rate with normal or above normal peak cardio respiratory capacity VO2max 45 96 That said patients with McArdle disease typically experience symptoms of exercise intolerance before the age of 10 years 45 with the median symptomatic age of 3 years 58 97 Tarui disease GSD VII patients do not experience the second wind phenomenon instead are said to be out of wind 45 59 98 However they can achieve sub maximal benefit from lipid metabolism of free fatty acids during aerobic activity following a warm up 45 Epidemiology edit nbsp Relative incidences of the main types of glycogen storage disease Overall according to a study in British Columbia approximately 2 3 children per 100 000 births 1 in 43 000 have some form of glycogen storage disease 99 In the United States they are estimated to occur in 1 per 20 000 25 000 births 10 Dutch incidence rate is estimated to be 1 per 40 000 births While a Mexican incidence showed 6 78 1000 male newborns 12 100 Within the category of muscle glycogenoses muscle GSDs McArdle disease GSD V is by far the most commonly diagnosed 58 See also editMetabolic myopathies Inborn errors of carbohydrate metabolismReferences edit Cantu Reyna C Santos Guzman J Cruz Camino H Vazquez Cantu D L Gongora Cortez J J Gutierrez Castillo A 2019 Glucose 6 Phosphate dehydrogenase deficiency incidence in a Hispanic population Journal of Neonatal Perinatal Medicine 12 2 203 207 doi 10 3233 NPM 1831 PMID 30741698 S2CID 73452760 Stegelmeier BL Molyneux RJ Elbein AD James LF May 1995 The lesions of locoweed Astragalus mollissimus swainsonine and castanospermine in rats Veterinary Pathology 32 3 289 98 doi 10 1177 030098589503200311 PMID 7604496 S2CID 45016726 a b c Stojkovic Tanya Vissing John Petit Francois Piraud Monique Orngreen Mette C Andersen Grete Claeys Kristl G Wary Claire Hogrel Jean Yves Laforet Pascal 2009 07 23 Muscle Glycogenosis Due to Phosphoglucomutase 1 Deficiency New England Journal of Medicine 361 4 425 427 doi 10 1056 NEJMc0901158 ISSN 0028 4793 PMID 19625727 a b c d Glycogen Metabolism Themedicalbiochemistrypage org 29 April 2020 Retrieved 5 July 2022 Glycogen Storage Diseases Cleveland Clinic Retrieved 2023 12 29 Glycogen Storage Disease Type 0 GSD 0 Glycogen Synthetase Deficiency Background Pathophysiology Epidemiology 2022 10 10 a href Template Cite journal html title Template Cite journal cite journal a Cite journal requires journal help a b c GLYCOGEN STORAGE DISEASE 0 MUSCLE GSD0B www omim org Retrieved 2023 12 29 a b Glycogen Storage Disease type 0 PDF MedLine 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study of 40 patients Brain A Journal of Neurology 143 2 452 466 doi 10 1093 brain awz410 ISSN 1460 2156 PMC 7009512 PMID 32040565 RIPPLING MUSCLE DISEASE 1 RMD1 www omim org Retrieved 2023 12 28 RIPPLING MUSCLE DISEASE 2 RMD2 www omim org Retrieved 2023 12 28 a b ERYTHROCYTE LACTATE TRANSPORTER DEFECT www omim org Retrieved 2023 12 28 MUSCULAR DYSTROPHY LIMB GIRDLE AUTOSOMAL RECESSIVE 23 LGMDR23 www omim org Retrieved 2023 12 28 MYOFIBRILLAR MYOPATHY 10 MFM10 www omim org Retrieved 2023 12 28 MUSCULAR DYSTROPHY LIMB GIRDLE AUTOSOMAL RECESSIVE 28 LGMDR28 www omim org Retrieved 2023 12 28 MUSCULAR DYSTROPHY LIMB GIRDLE AUTOSOMAL RECESSIVE 8 LGMDR8 www omim org Retrieved 2023 12 28 MUSCULAR DYSTROPHY DYSTROGLYCANOPATHY LIMB GIRDLE TYPE C 3 MDDGC3 www omim org Retrieved 2023 12 28 Heydemann Ahlke 2018 06 20 Skeletal Muscle Metabolism in Duchenne and Becker Muscular Dystrophy Implications for Therapies Nutrients 10 6 796 doi 10 3390 nu10060796 ISSN 2072 6643 PMC 6024668 PMID 29925809 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omim org Retrieved 2023 11 11 MYOPATHY TUBULAR AGGREGATE 2 TAM2 www omim org Retrieved 2023 11 11 SATOYOSHI SYNDROME www omim org Retrieved 2023 12 28 DIMETHYLGLYCINE DEHYDROGENASE DEFICIENCY DMGDHD www omim org Retrieved 2023 12 28 MYOPATHY WITH MYALGIA INCREASED SERUM CREATINE KINASE AND WITH OR WITHOUT EPISODIC RHABDOMYOLYSIS MMCKR www omim org Retrieved 2023 12 28 Glycogen Storage Disease Type I NORD National Organization for Rare Disorders NORD National Organization for Rare Disorders Retrieved 23 March 2017 Lokken Nicoline Hansen Kit K Storgaard Jesper H Orngreen Mette C Quinlivan Ros Vissing John July 2020 Titrating a modified ketogenic diet for patients with McArdle disease A pilot study Journal of Inherited Metabolic Disease 43 4 778 786 doi 10 1002 jimd 12223 ISSN 0141 8955 PMID 32060930 S2CID 211121921 Lokken Nicoline Voermans Nicol C Andersen Linda K Karazi Walaa Reason Stacey L Zweers Heidi Wilms Gustav Santalla Alfredo Susanibar Edward Lucia Alejandro Vissing John 2023 02 07 Patient Reported Experiences with a Low Carbohydrate Ketogenic Diet An International Survey in Patients with McArdle Disease Nutrients 15 4 843 doi 10 3390 nu15040843 ISSN 2072 6643 PMC 9964801 PMID 36839201 a b Kitaoka Yu February 25 2014 McArdle Disease and Exercise Physiology Biology 3 1 157 166 doi 10 3390 biology3010157 ISSN 2079 7737 PMC 4009758 PMID 24833339 a b c d e f Salazar Martinez Eduardo Santalla Alfredo Valenzuela Pedro L Nogales Gadea Gisela Pinos Tomas Moran Maria Santos Lozano Alejandro Fiuza Luces Carmen Lucia Alejandro 2021 The Second Wind in McArdle Patients Fitness Matters Frontiers in Physiology 12 744632 doi 10 3389 fphys 2021 744632 ISSN 1664 042X PMC 8555491 PMID 34721068 a b Perez M Martin M A Rubio J C Mate Munoz J L Gomez Gallego F Foster C Andreu A L Arenas J Lucia A August 2006 Exercise capacity in a 78 year old patient with McArdle s disease it is never too late to start exercising British Journal of Sports Medicine 40 8 725 726 doi 10 1136 bjsm 2006 026666 ISSN 0306 3674 PMC 2579473 PMID 16864568 Wakelin Andrew 2013 101Tips for a good life with McArdle Disease PDF AGSD UK p 52 Perez Margarita Ruiz Jonatan R Fernandez del Valle Maria Nogales Gadea Gisela Andreu Antoni L Arenas Joaquin Lucia Alejandro 2009 06 01 The second wind phenomenon in very young McArdle s patients Neuromuscular Disorders 19 6 403 405 doi 10 1016 j nmd 2009 04 010 ISSN 0960 8966 PMID 19477644 S2CID 31541581 Scalco Renata Siciliani Morrow Jasper M Booth Suzanne Chatfield Sherryl Godfrey Richard Quinlivan Ros September 2017 Misdiagnosis is an important factor for diagnostic delay in McArdle disease Neuromuscular Disorders 27 9 852 855 doi 10 1016 j nmd 2017 04 013 ISSN 1873 2364 PMID 28629675 S2CID 11797963 Stojan George Christopher Stine Lisa 2015 01 01 Hochberg Marc C Silman Alan J Smolen Josef S Weinblatt Michael E eds 151 Metabolic drug induced and other noninflammatory myopathies Rheumatology Sixth Edition Philadelphia Mosby pp 1255 1263 ISBN 978 0 323 09138 1 retrieved 2023 05 15 Applegarth DA Toone JR Lowry RB January 2000 Incidence of inborn errors of metabolism in British Columbia 1969 1996 Pediatrics 105 1 e10 doi 10 1542 peds 105 1 e10 PMID 10617747 S2CID 30266513 Cantu Reyna Consuelo Zepeda Luis Manuel Montemayor Rene Benavides Santiago Gonzalez Hector Javier Vazquez Cantu Mercedes Cruz Camino Hector 27 September 2016 Incidence of Inborn Errors of Metabolism by Expanded Newborn Screening in a Mexican Hospital PDF Journal of Inborn Errors of Metabolism and Screening 4 232640981666902 doi 10 1177 2326409816669027 External links editAGSD Association for Glycogen Storage Disease A US based non profit parent and patient oriented support group dedicated to promoting the best interest of all the different types of glycogen storage disease AGSD UK Association for Glycogen Storage Disease UK A UK based charity which helps individuals and families affected by Glycogen Storage Disease by putting people in contact providing information and support publishing a magazine and holding conferences workshops courses and family events IamGSD International Association for Muscle Glycogen Storage Disease A non profit patient led international group encouraging efforts by research and medical professionals national support groups and individual patients worldwide IPA International Pompe Association Pompe Disease is also known as GSD II A non profit federation of Pompe disease patient s groups world wide It seeks to coordinate activities and share experience and knowledge between different groups EUROMAC EUROMAC is a European registry of patients affected by McArdle Disease and other rare neuromuscular glycogenoses CoRDS Coordination of Rare Diseases at Sanford CoRDS is a centralized international patient registry for all rare diseases They work with patient advocacy groups including IamGSD individuals and researchers CORD Canadian Organization for Rare Disorders CORD is a Canadian national network for organizations representing all those with rare disorders CORD provides a strong common voice to advocate for health policy and a healthcare system that works for those with rare disorders NORD National Organization for Rare Disorders NORD is an American national non profit patient advocacy organization that is dedicated to individuals with rare diseases and the organizations that serve them EURODIS Rare Diseases Europe EURODIS is a unique non profit alliance of over 700 rare disease patient organizations across Europe that work together to improve the lives of the 30 million people living with a rare disease in Europe Retrieved from https en wikipedia org w index php title Glycogen storage disease amp oldid 1218561269, wikipedia, wiki, book, books, library,

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