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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/03/24 09:47:05」(JST)

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Whipple's triad is a collection of three criteria (called Whipple's criteria) that suggest a patient's symptoms result from hypoglycemia which may indicate insulinoma. 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[edit]

The criteria date back to the 1930s, when it had been discovered that a few patients with hypoglycemic symptoms (such as shakiness, syncope, 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 hormones and metabolites such as insulin, and 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 of the triad[edit]

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 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.

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1. 成人における低血糖：臨床症状、定義、および原因 hypoglycemia in adults clinical manifestations definition and causes
2. 糖尿病でない成人における低血糖症：診断的アプローチ hypoglycemia in adults without diabetes mellitus diagnostic approach
3. 低血糖における診断ジレンマ：具体例 diagnostic dilemmas in hypoglycemia illustrative cases
4. 食後の（反応性）低血糖 postprandial reactive hypoglycemia

English Journal

Road Accident due to a Pancreatic Insulinoma: A Case Report.

Parisi A1, Desiderio J, Cirocchi R, Grassi V, Trastulli S, Barberini F, Corsi A, Cacurri A, Renzi C, Anastasio F, Battista F, Pucci G, Noya G, Schillaci G.
Medicine.Medicine (Baltimore).2015 Mar;94(12):e537. doi: 10.1097/MD.0000000000000537.
Insulinoma is a rare pancreatic endocrine tumor, typically sporadic and solitary. Although the Whipple triad, consisting of hypoglycemia, neuroglycopenic symptoms, and symptoms relief with glucose administration, is often present, the diagnosis may be challenging when symptoms are less typical.We re
PMID 25816027

[Non diabetic hypoglycemia: diagnosis and management].

Dufey A1, Köhler Ballan B, Philippe J.
Revue médicale suisse.Rev Med Suisse.2013 Jun 5;9(389):1186-8, 1190-1.
Organic or non diabetic hypoglycemia (NDH) is a rare disease when it is confirmed, but is often confounded with low blood glucose concentration (between 3 and 4 mmol/I), which is much more frequent. NDH's definition requires the Whipple triad (plasma glucose level <2.8 mmol/l, symptoms of neurogl
PMID 23798188

[A case of glucose-sensitive insulinoma accompanied by slightly elevated serum insulin levels and persisting convulsions after the surgically removed neuroendocrine tumor].

Soós Z1, Czégeni A, Salamon F, Salamon M, Kenessey I, Folyovich A, Tihanyi T, Winkler G.
Orvosi hetilap.Orv Hetil.2013 Jan 13;154(2):69-73. doi: 10.1556/OH.2013.29522.
Insul(in)oma is a usually solitary or, in some cases, multifocal tumor of pancreatic beta cells. It may be a component of multiple endocrine neoplasia type 1. or von Hippel-Lindau syndrome. In typical forms the diagnosis - based on the Whipple triad - is simple, however, it may be difficult to recog
PMID 23291205

Japanese Journal

乳幼児ファロー四徴症におけるβ遮断薬服用と低血糖発作の頻度およびその危険因子の検討

伊藤怜司,小川潔,森琢磨,菅本健司,菱谷隆,星野健司,野村耕司,関島俊雄,目澤秀俊,井田博幸
Pediatric Cardiology and Cardiac Surgery 29(3), 129-136, 2013
背景:β遮断薬は小児においても循環器疾患を中心に用いられるが,低血圧,徐脈,低血糖といった副作用が問題となることがある。特に低血糖は重大な後遺症を来す可能性があるが,小児における頻度や危険因子は明らかではない。目的:乳幼児ファロー四徴症におけるβ遮断薬服用の有無と低血糖発症の関連性を明らかにし,その危険因子を明らかにすること。方法:1983 年4 月～ 2011 年1 月に受診したファロー四徴症4 …
NAID 130003380027

脾への広範な浸潤を認めた膵島腫瘍の1例

森隆太郎,簾田康一郎,松山隆生,長谷川聡,名取志保,長谷川誠司,仲野明,小林俊介,家本陽一
日本消化器外科学会雑誌 37(8), 1438-1442, 2004-08-01
… 症例は49歳の女性で,Whippleの3徴を認めたため,当科を受診した.臨床的にはインスリノーマと考えられたが,画像診断では膵に明らかな腫瘤を認めず.脾に径11cmの腫瘤を認めた.局在不明のインスリノーマおよび脾腫瘍の診断で開腹術を行った.術中超音波所見では膵頭体部に腫瘤はなく,膵尾部末端から脾に連続して腫瘤を形成しており,膵尾部・脾合併切除術を施行した.術中インスリン濃度の著明な低下で腫瘍の完全摘出を確 …
NAID 10014054369

Malignant Insulinoma with Extensive Liver Metastases Presenting as Disturbance of Consciousness

Toyoda Chizuko,Hosokawa Kazuhiro,Atsumi Yoshihito [他],ASAHINA Sousuke,SHIMADA Akira,MOKUBO Atsuko,MATSUOKA Kenpei,MORINAGA Shojiroh,HAYASHI Fumihiro,HIKITA Miho,TOMONARI Haruo,KURIYAMA Satoru,INOUE Kiyoharu,HOSOYA Tatsuo
Internal medicine 37(5), 476-479, 1998-05
… Hypoglycemic symptoms were noted and Whipple's triad was satisfied. …
NAID 10007010020

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英: Whipple triad, Whipple's triad
同: Whippleの三徴
関: インスリノーマ

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ホウィップルの三徴 : 1 件
Whipple三徴 : 11 件
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ウィップル三徴 : 10 件
Whippleの三徴 : 72 件

1. 空腹時の定型的低血糖発作の出現
2. 空腹時血糖値が50mg/dl以下
3. ブドウ糖投与で症状が速やかに回復

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Whipple triad