Whipple's triad

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Whipple's triad
Other namesWhipple's criteria
Symptomssymptoms of hypoglycaemia, low blood plasma glucose concentration, relief of symptoms when plasma glucose concentration increased
Differential diagnosishypoglycemia

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 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:

  1. Symptoms known or likely to be caused by hypoglycaemia, especially after fasting or intense exercise.[1][2] These symptoms include tremor, tachycardia, anxiety, dizziness, and loss of consciousness.[3]
  2. A low blood plasma glucose concentration measured at the time of the symptoms.[1][2] This may be measured as a blood plasma glucose concentration of less than 550 milligrams per litre.[2]
  3. 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 and

endocrinologists than by surgeons. The radiological investigation of choice now is endoscopic and/or intraoperative ultrasonography.[citation needed
]

Differential diagnosis

Whipple's triad is not exclusive for insulinoma, and other conditions will also be considered.[2] The same signs may be caused by hyperinsulinism not caused by insulinoma.[4]

History

The criteria date back to the 1930s, when a few patients with hypoglycaemic symptoms (such as shakiness,

organs such as the pancreas.[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.

See also

References