Whipple's triad
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Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch. Whipple's triad or Whipple's criteria is a medical term which refers to three conditions that are considered by physicians necessary for proving hypoglycemia as the cause of a person's symptoms. They are 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
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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 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
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. The reliability of the criteria for this purpose has been a subject of contention among physicians.
In Popular Culture
Elliot in the tv series Scrubs was unable to name Whipple's Triad in the episode "My Balancing Act".
See also
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
