Whipple's triad

Whipple's triad is a collection of three criteria (called Whipple's criteria) that suggests a patient's symptoms result from hypoglycemia that may indicate insulinoma. The triad is stated in various versions, but the essential conditions are:[1]

  1. Symptoms known or likely to be caused by hypoglycemia, especially after fasting or heavy exercise
  2. A low plasma glucose measured at the time of the symptoms
  3. Relief of symptoms when glucose level is raised
Not to be confused with Whipple's disease or Whipple procedure.
Whipple's triad
Differential diagnosishypoglycemia

History

The criteria date back to the 1930s, when a few patients with hypoglycemic symptoms (such as shakiness, syncope, or sweating) due to hypoglycemia were found to be cured by surgery to remove an insulinoma, but a large proportion of people with symptoms suggestive of hypoglycemia apparently had no need of surgery. Diagnostic testing was rudimentary; beyond a crude assay for reducing substances as an indirect measure of blood glucose, no way had yet been found to measure hormones and metabolites such as insulin, with no imaging procedures for internal organs such as the pancreas.

Allen O. Whipple was a well-known surgeon who had pioneered pancreatic surgery. In an article entitled "The surgical therapy of hyperinsulinism", in J Internat Chir 3:237-276 (1938), he proposed that no pancreatic surgery to look for an insulinoma be performed unless these criteria were met.

Current use

The use and significance of the criteria have evolved over the last century as understanding of the many forms of hypoglycemia 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 hypoglycemia" (in which a low glucose can be demonstrated) from a variety of other conditions (e.g., idiopathic postprandial syndrome) in which symptoms suggestive of hypoglycemia 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.

See also

References
  1. Melmed, Shlomo (2016). Williams textbook of endocrinology (13 ed.). Elsevier. pp. 1582–1607. ISBN 978-0-323-29738-7.
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