Whipple's triad 1094670 213824817 2008-05-20T23:34:05Z Diberri 35331 copyedit '''Whipple's triad''' is a collection of three criteria (called '''Whipple's criteria''') that suggest a patient's [[symptom]]s result from [[hypoglycemia]]. The triad is stated in various versions, but the essential conditions are: #Symptoms known or likely to be caused by hypoglycemia #A low 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, [[syncope]] or [[diaphoresis|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 substance]]s as an indirect measure of blood [[glucose]], there was no way to measure [[hormone]]s and metabolites such as [[insulin]], and no [[radiology|imaging procedures]] for internal [[organ (anatomy)|organ]]s such as the [[pancreas]]. [[Allen Whipple|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== 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 [[medical test|diagnostic test]]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 [[endocrinologist]]s than by surgeons. The reliability of the criteria for this purpose has been a subject of contention among physicians. ==In Popular Culture== In the episode "[[My Balancing Act]]" of the TV series [[Scrubs(series)|Scrubs]], Elliot was unable to name Whipple's Triad. ==See also== * [[Hypoglycemia]] * [[Causes of hypoglycemia]] {{medical-stub}} [[Category:Endocrinology]]