Whipple's triad
Encyclopedia
Whipple's triad is a collection of three criteria (called Whipple's criteria) that suggest a patient's symptom
s result from hypoglycemia
that may indicate insulinoma
. The triad is stated in various versions, but the essential conditions are:
, or sweating
) due to hypoglycemia could be cured by surgery
to remove an insulinoma
. However, it had also become apparent that a large proportion of people with symptoms suggestive of hypoglycemia had no need of surgery. Diagnostic testing was rudimentary: beyond a crude assay for reducing substances as an indirect measure of blood glucose
, there was no way to measure hormone
s and metabolites such as insulin
, and no imaging procedures
for internal organ
s 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.
s 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.
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s result from hypoglycemia
Hypoglycemia
Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...
that may indicate insulinoma
Insulinoma
An insulinoma is a tumour of the pancreas that is derived from beta cells and secretes insulin.Beta cells secrete insulin in response to increases in blood glucose. The resulting increase in insulin acts to lower blood glucose back to normal levels at which point further secretion of insulin is...
. The triad is stated in various versions, but the essential conditions are:
- Symptoms known or likely to be caused by hypoglycemia
- A low plasma glucose measured at the time of the symptoms
- Relief of symptoms when the glucose is raised to normal
History
The criteria date back to the 1930s, when it had been discovered that a few patients with hypoglycemic symptoms (such as shakiness, syncopeSyncope (medicine)
Syncope , the medical term for fainting, is precisely defined as a transient loss of consciousness and postural tone characterized by rapid onset, short duration, and spontaneous recovery due to global cerebral hypoperfusion that most often results from hypotension.Many forms of syncope are...
, or sweating
Diaphoresis
Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions.Diaphoretic is the state of perspiring profusely, or something that has the power to cause increased perspiration....
) due to hypoglycemia could be cured by surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
to remove an insulinoma
Insulinoma
An insulinoma is a tumour of the pancreas that is derived from beta cells and secretes insulin.Beta cells secrete insulin in response to increases in blood glucose. The resulting increase in insulin acts to lower blood glucose back to normal levels at which point further secretion of insulin is...
. However, it had also become apparent that a large proportion of people with symptoms suggestive of hypoglycemia had no need of surgery. Diagnostic testing was rudimentary: beyond a crude assay for reducing substances as an indirect measure of blood glucose
Glucose
Glucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...
, there was no way to measure hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
s and metabolites such as insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
, and no imaging procedures
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...
for internal organ
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...
s such as the pancreas
Pancreas
The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
.
Allen O. Whipple
Allen Whipple
Allen Oldfather Whipple was an American surgeon who is known for the pancreatic cancer operation which bears his name as well as Whipple's triad....
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 of the triad
The use and significance of the criteria have evolved over the last century as our understanding of the many forms of hypoglycemia has increased and our diagnostic testMedical test
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. For example:* to diagnose diseases, and preferably sub-classify it regarding, for example, severity and treatability...
s 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
Idiopathic postprandial syndrome
Idiopathic postprandial syndrome is a medical term describing a collection of symptoms popularly attributed to hypoglycemia but without demonstrably low blood glucose levels.People with this condition suffer from recurrent episodes of altered mood and cognitive...
) 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.
See also
- HyperinsulinismHyperinsulinismHyperinsulinism refers to an above normal level of insulin in the blood of a person or animal. Normal insulin secretion and blood levels are closely related to the level of glucose in the blood, so that a given level of insulin can be normal for one blood glucose level but low or high for another...
- HypoglycemiaHypoglycemiaHypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...
- Causes of hypoglycemia