David H.P. Streeten, MB, DPhil, FRCP
David Streeten was born, educated, and began his life’s work in South Africa. He distinguished himself early by graduating with distinction from the University of South Africa in Bloemfontein and with first-class honors from the Medical School at the University of Witwatersrand. After 2 years as a house officer, he moved to the University of Oxford, where he obtained his DPhil degree while collaborating extensively with E.M. Vaughn Williams. Although this experience launched his research career, the subject of his investigations, intestinal motility, was never revisited. From Oxford, he came to the United States, where he trained with George Thorn in Endocrinology at the Peter Bent Brigham Hospital. There, his research centered about the actions of corticotropin and hydrocortisone. His first full-time faculty position was in Ann Arbor at the University of Michigan as an Assistant Professor in the Division of Endocrinology and Metabolism. While working there with Drs Jerome Conn and Stefan Fajans, he established a novel bioassay for the newly discovered aldosterone. This assay was used to make the first confirmed diagnosis of primary aldosteronism as a new secondary cause of hypertension. While in Ann Arbor, he also became interested in periodic paralysis, diabetes, and autonomic control of the circulation, which occupied much of his research attention for the rest of his career. In 1960, we had the good fortune to recruit him to the University Hospital of the State University of New York at Syracuse, where he began and led the Endocrinology Division in the Department of Medicine until his retirement in 1994. As an Emeritus Professor, he continued to carry out research and wrote actively until September 24, 2000, when he suffered a cerebral hemorrhage while working on a manuscript. He died 5 days later on September 29, 2000. The funeral was held on October 3, 2000, which would have been his 79th birthday. It tells much about the man that during the 6 years between his retirement until his death, he published 8 book chapters, 20 abstracts, and 29 articles (including 1 published posthumously).
As an eminent endocrinologist, he was well known for his expertise and research in the multiple actions of corticotropin and adrenocorticosteroids as well as the functions of the pituitary gland, with special reference to Cushing’s disease. He also made many contributions to the understanding of otherwise poorly defined illnesses where most clinical investigators feared to tread. These disorders included periodic paralysis, idiopathic edema, and chronic fatigue syndromes. He was an ideal faculty member because the breadth of his interests carried his endocrinologic research across multidisciplinary lines. In addition to the circulation, his work involved collaboration with gastroenterology, nephrology, nutrition, pediatrics, pulmonary medicine, psychology, radiology, rehabilitation medicine, and general and cardiac surgery.
For much of his career, however, Dr Streeten was occupied with the control of the blood pressure and its disorders, both high and low. His early interest in hypertension led to investigations of the renin-angiotensin system, with some of the earliest descriptions of the effects of the first clinically used angiotensin II antagonist, saralasin. This, in turn, led to an interest in the study of patients with renovascular hypertension and, when coupled with earlier studies in primary aldosteronism, to a search for patients with all forms of secondary hypertension. In Syracuse, he organized a National Institutes of Health–supported program for the routine study of individual hypertensive patients. This protocol consisted of a thorough 1-day workup of each patient, at a time when routine investigation of hypertension for secondary causes was neither popular nor recommended. The program investigated some 5000 patients and identified large numbers of individuals with secondary forms of hypertension who might have otherwise gone undetected. The description of hypertension associated with hypothyroidism was one of the results of this survey. His interest in blood pressure control also led to the study of patients with hypotension. He investigated orthostatic hypotension extensively and published the classic monograph on this subject titled Orthostatic Disorders of the Circulation: Mechanisms, Manifestations and Treatment (New York: Plenum Medical, 1986). In this entity, he described the autonomic failure of the leg veins to contract normally when such patients assume the standing position. These studies in errors of autonomic control and dysautonomia led him to establish, with Dr David Robertson, the American Autonomic Society, which was the forerunner of the National Dysautonomia Research Foundation. He was a charter member of the Society and its president from 1995 to 1996, and in July 2000, the Foundation presented him with its Lifetime Achievement Award. In addition, he was a charter member of the American Society of Hypertension and in 1998 was awarded the Irvine Page–Alva Bradley Lifetime Achievement Award by the Council for High Blood Pressure Research of the American Heart Association. In England, he was a Fellow of the Royal College of Physicians (London), of the National Council for High Blood Pressure Research, and of the International Society of Hypertension.
National and international recognition for scholarly achievement aside, he made major contributions at home. Students and house officers were uniformly impressed with his empathetic attention to patients and his willingness to study those patients whose previous physicians had been unable to understand or help. This attention provided comfort to these patients and insights to their skeptical physicians. Some of his medical knowledge and personal wisdom is still carried by all who interacted with him at our Medical Center. We all miss him, and he will be long remembered by students and by colleagues but probably most by his Endocrinology Fellows, on whom he had the utmost influence.
Over the many years that I had the good fortune to know Dave Streeten, what stood out most in my mind was his kind and gentle nature, his inquisitive and open mind to perplexing clinical problems, and, most recently, his willingness to review any manuscript and to offer to the readers significant comments or generous praise. He certainly was deserving of the Council’s Irving Page–Alva Brady Lifetime Achievement Award. He was a fine gentleman who will certainly be missed by his friends, colleagues, and our hypertension research community.