| Whipple's triad | |
|---|---|
| Other names | Whipple's criteria |
| Symptoms | symptoms ofhypoglycaemia, lowblood plasmaglucoseconcentration, relief of symptoms when plasma glucose concentration increased |
| Differential diagnosis | hypoglycemia |
Whipple's triad is a collection of three signs (calledWhipple's criteria) that suggests that a patient'ssymptoms result fromhypoglycaemia that may indicateinsulinoma. The essential conditions are symptoms of hypoglycaemia, lowblood plasmaglucoseconcentration, and relief of symptoms when plasma glucose concentration is increased. It was first described by thepancreaticsurgeonAllen Whipple, who aimed to establish criteria forexploratory pancreatic surgery to look for insulinoma.
Whipple's triad is stated in various versions. The essential conditions are:
The use and significance of the criteria have evolved over the last century as understanding of the many forms of hypoglycaemia has increased anddiagnostic tests and imaging procedures have improved. Whipple's criteria are no longer used to justify surgical exploration for an insulinoma, but to separate "true hypoglycaemia" (in which a low glucose can be demonstrated) from a variety of other conditions (e.g.,idiopathic postprandial syndrome) in which symptoms suggestive of hypoglycaemia occur, but low glucose levels cannot be demonstrated. The criteria are now invoked far more often byendocrinologists than by surgeons. The radiological investigation of choice now is endoscopic and/or intraoperative ultrasonography.[citation needed]
Whipple's triad is not exclusive forinsulinoma, and other conditions will also be considered.[2] The same signs may be caused byhyperinsulinism not caused by insulinoma.[4]
The criteria date back to the 1930s, when a few patients with hypoglycaemic symptoms (such as shakiness,syncope, orsweating) due to hypoglycaemia were found to be cured bysurgery to remove aninsulinoma, but a large proportion of people with symptoms suggestive of hypoglycaemia apparently had no need of surgery. Diagnostic testing was rudimentary; beyond a crude assay forreducing substances as an indirect measure of bloodglucose, no way had yet been found to measurehormones and metabolites such asinsulin, with noimaging procedures for internalorgans such as thepancreas.[citation needed]
Allen Whipple was a well-known surgeon who had pioneered pancreatic surgery. He proposed that no pancreatic surgery to look for insulinoma be performed unless these criteria were met.[5] For this reason, Whipple's triad is also known as Whipple's criteria.