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Paul, Clearly I agree with you that the TnI and TnT results would rule out a cardiac cause for the elevations in CK and CKMB, but to simply state that it is non-cardiac is a bit unsatisfying. Since the high CKMB/CK ratio tends to rule out skeletal muscle souces, I am left with only the possibility of a CK/CKMB secreting tumor or similar source. For example a brief Medlines search turned up the case of a pheochromacytoma with a similar pattern, albeit the elevations were more modest. Lamberts R, Kreuzer H, Pheochromocytoma-induced multiorgan failure. An internal medicine and surgical emergency. Dtsch Med Wochenschr 1996 Apr 12;121(15):479-84 If Geoff has more information about the patient, this might be an interesting case. maurice green, phd clinical chemist stanford hospital palo alto, ca %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%