Whipple's triad is a collection of three signs (called Whipple's criteria) that suggests that a patient's
symptoms result from
hypoglycaemia that may indicate
insulinoma. The essential conditions are symptoms of hypoglycaemia, low
blood plasma glucose
Glucose is a sugar with the Chemical formula#Molecular formula, molecular formula , which is often abbreviated as Glc. It is overall the most abundant monosaccharide, a subcategory of carbohydrates. It is mainly made by plants and most algae d ...
concentration, and relief of symptoms when plasma glucose concentration is increased. It was first described by the
pancreatic surgeon Allen Whipple, who aimed to establish criteria for
exploratory pancreatic surgery to look for insulinoma.
Definition
Whipple's triad is stated in various versions. The essential conditions are:
# Symptoms known or likely to be caused by
hypoglycaemia, especially after
fasting or
intense exercise.
These symptoms include
tremor,
tachycardia,
anxiety,
dizziness, and
loss of consciousness.
# A low blood plasma
glucose
Glucose is a sugar with the Chemical formula#Molecular formula, molecular formula , which is often abbreviated as Glc. It is overall the most abundant monosaccharide, a subcategory of carbohydrates. It is mainly made by plants and most algae d ...
concentration measured at the time of the symptoms.
This may be measured as a blood plasma glucose concentration of less than 550
milligrams per
litre.
# Relief of symptoms when glucose level is increased.
The use and significance of the criteria have evolved over the last century as understanding of the many forms of hypoglycaemia has increased and
diagnostic 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 by
endocrinologists than by surgeons. The radiological investigation of choice now is endoscopic and/or intraoperative ultrasonography.
Differential diagnosis
Whipple's triad is not exclusive for
insulinoma, and other conditions will also be considered.
The same signs may be caused by
hyperinsulinism not caused by insulinoma.
History
The criteria date back to the 1930s, when a few patients with hypoglycaemic symptoms (such as shakiness,
syncope, or
sweating) due to hypoglycaemia were found to be cured by
surgery
Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...
to remove an
insulinoma, 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 for
reducing substances as an indirect measure of blood
glucose
Glucose is a sugar with the Chemical formula#Molecular formula, molecular formula , which is often abbreviated as Glc. It is overall the most abundant monosaccharide, a subcategory of carbohydrates. It is mainly made by plants and most algae d ...
, no way had yet been found to measure
hormone
A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...
s and metabolites such as
insulin
Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (''INS)'' gene. It is the main Anabolism, anabolic hormone of the body. It regulates the metabol ...
, with no
imaging procedures for internal
organs such as the
pancreas
The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...
.
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.
For this reason, Whipple's triad is also known as Whipple's criteria.
See also
*
Hyperinsulinism
*
Hypoglycemia
Hypoglycemia (American English), also spelled hypoglycaemia or hypoglycæmia (British English), sometimes called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's tria ...
*
Causes of hypoglycemia
References
{{DEFAULTSORT:Whipple's Triad
Symptoms and signs: Endocrinology, nutrition, and metabolism
Medical triads
Eponyms in medicine