Whipple's triad
| 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 triadis a collection of three signs (calledWhipple's criteria) that suggests that a patient'ssymptomsresult fromhypoglycaemiathat 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 surgeryto look for insulinoma.
Definition[edit]
Whipple's triad is stated in various versions. The essential conditions are:
- Symptoms known or likely to be caused byhypoglycaemia,especially afterfastingorintense exercise.[1][2]These symptoms includetremor,tachycardia,anxiety,dizziness,andloss of consciousness.[3]
- A low blood plasmaglucoseconcentration measured at the time of the symptoms.[1][2]This may be measured as a blood plasma glucose concentration of less than 550milligramsperlitre.[2]
- Relief of symptoms when glucose level is increased.[1][2]
The use and significance of the criteria have evolved over the last century as understanding of the many forms of hypoglycaemia has increased anddiagnostic testsand 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 byendocrinologiststhan by surgeons. The radiological investigation of choice now is endoscopic and/or intraoperative ultrasonography.[citation needed]
Differential diagnosis[edit]
Whipple's triad is not exclusive forinsulinoma,and other conditions will also be considered.[2]The same signs may be caused byhyperinsulinismnot caused by insulinoma.[4]
History[edit]
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 bysurgeryto 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 substancesas an indirect measure of bloodglucose,no way had yet been found to measurehormonesand metabolites such asinsulin,with noimaging proceduresfor internalorganssuch as thepancreas.[citation needed]
Allen Whipplewas 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.
See also[edit]
References[edit]
- ^abcMelmed, Shlomo (2016).Williams textbook of endocrinology(13 ed.). Elsevier. pp. 1582–1607.ISBN978-0-323-29738-7.
- ^abcdeMartens, Pieter; Tits, Jos (2014-06-01)."Approach to the patient with spontaneous hypoglycemia".European Journal of Internal Medicine.25(5): 415–421.doi:10.1016/j.ejim.2014.02.011.ISSN0953-6205.PMID24641805– viaScienceDirect.
- ^Desimone, Marisa E.; Weinstock, Ruth S. (2000), Feingold, Kenneth R.; Anawalt, Bradley; Blackman, Marc R.; Boyce, Alison (eds.),"Hypoglycemia",Endotext,South Dartmouth (MA): MDText.com, Inc.,PMID25905360,retrieved2023-10-27
- ^Cazabat, L.; Chanson, P. (2009-09-01)."Hypoglycémie et insulinome".Annales d'Endocrinologie.70:S2–S11.doi:10.1016/S0003-4266(09)72470-9.ISSN0003-4266.PMID19878764– viaScienceDirect.
- ^Whipple, Allen O (1938)."The surgical therapy of hyperinsulinism".International Journal of Surgery.3:237–276 – viaScopus.