Some metabolic myopathies involve the under- or over-utilization of the purine nucleotide cycle. Metabolic myopathies cause a low ATP reservoir in muscle cells (ADP > ATP),  resulting in exercise-induced excessive AMP buildup in muscle, and subsequent exercise-induced hyperuricemia (myogenic hyperuricemia) through conversion of excessive AMP into uric acid by way of either AMP → adenosine or AMP → IMP.
During strenuous exercise, AMP is created through the use of the adenylate kinase (myokinase) reaction after the phosphagen system has been depleted of creatine phosphate and not enough ATP is being produced yet by other pathways (see above reaction in Occurrence section). In those affected by metabolic myopathies, exercise that normally wouldn't be considered strenuous for healthy people, is however strenuous for them due to their low ATP reservoir in muscle cells. This results in regular use of the myokinase reaction for normal, everyday activities.
Besides the myokinase reaction, a high ATP consumption and low ATP reservoir also increases protein catabolism and salvage of IMP, which results in increased AMP and IMP. These two nucleotides can then enter the purine nucleotide cycle to produce fumarate which will then produce ATP by oxidative phosphorylation. If the purine nucleotide cycle is blocked (such as AMP deaminase deficiency) or if exercise is stopped and increased fumarate production is no longer needed, then the excess nucleotides will be converted into uric acid.