b.3 October 1921 d.29 September 2000
BSc MB BCh Wits(1946) MRCP(1948) DPhil Oxon(1951) FRCP(1975)
David Streeten was a leading physician investigator in endocrinology, blood pressure and autonomic disorders. He had the good fortune to practice medicine on three continents, during the recent period of its most remarkable advances. He was born in Bloemfontein, South Africa, the son of a barrister, and graduated with first class honours in medicine from the University of Witwatersrand in 1946.
As an intern he conducted his first clinical experiment, successfully treating tuberculosis of the joints by direct injection of streptomycin after focal alkalinization. This was published in the South African Medical Journal. He spent the next three years as a Nuffield demonstrator at Oxford, pursuing a DPhil in pharmacology. These years were among his fondest memories; working amongst brilliant scientists and joining in the great variety of stimulating activities which abound in Oxford, where his father and grandfather also studied.
His fruitful collaboration at Oxford with E M Vaughn Williams was an extensive study on factors involved in the mechanism and treatment of paralytic ileus in an animal model, stimulated by seven patients with difficult bowel paralysis he had treated as a house officer in Johannesburg.
To learn more about the mechanisms and therapeutic usages of the exciting new adrenal corticosteroids he moved to the USA in 1951, on a Rockefeler travelling fellowship for three years of training with George Thorn at the Peter Bent Brigham Hospital in Boston. While there he learned that although he loved all of medicine, investigative endocrinology was the perfect field for him, and it became the core of his work for the next 40 years.
In 1953 he went to the University of Michigan where he worked with Jerome Conn and Stefan Fajans. As an assistant professor of medicine there and an investigator for the Howard Hughes Medical Institute, he established a novel bio-assay for the (then) new hormone, aldosterone. This assay was used to describe a new cause of hypertension, primary aldosteronism, in a patient being studied by Jerome Conn. This was the first individual in the world diagnosed with primary aldosteronism as a cause of hypertension, now routinely curable by the removal of the adrenal tumour. At the University of Michigan he also developed interests in periodic paralysis and autonomic function, the latter being a major research focus for the rest of his life. Streeten was recruited to Syracuse, New York, in 1960, where he served as professor of medicine and chief of the endocrinology section of the department of medicine, SUNY Upstate Medical University, until his official retirement in 1994.
In those early years in Syracuse, Streeten was involved in all phases of endocrinology, carrying out radioactive iodine uptakes and treatments of thyroid diseases himself, as well as setting up and running a laboratory for the full range of adrenal and pituitary evaluation for clinical and research work. He became especially interested in studying the mechanisms of blood pressure disorders and their treatment, developing a one-day outpatient procedure for diagnosing primary aldosteronism and other forms of 'secondary hypertension'. He used this procedure on over 5000 hypertensive patients, some hundreds of whom were cured by recognizing and treating the adrenal, renal and other mechanisms of their high blood pressure that his studies revealed. Through these and other mechanisms on his patients, he discovered three new forms of 'secondary hypertension'; hyperthyroid hypertension, orthostatic hypertension and primary hyperepinephrinaemia, all of which respond best to forms of treatment different from the non-specific use of anti-hypertensive agents.
Streeten 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.
Streeten's interest in blood pressure and postural disorders also led to studies of the mechanisms and clinical manifestations of low blood pressure. He demonstrated for the first time that a fall in blood pressure in the upright posture can result not only from a reduced circulating blood volume, but also from failure of the veins in the lower limbs to contract normally in the standing position. The combination of a low volume of circulating plasma and red blood cells, and excessive pooling of blood in the leg veins while standing, was shown to be the cause of ill-health involving fainting spells, chronic fatigue, and incapacitation which, when recognized, was remediable in many individuals, as outlined in his classic text on Orthostatic disorders of the circulation (New York, Plenum Medical, 1987).
His interest in dysautonomia led him to establish, along with David Robertson and others, the American Autonomic Society, of which he was president. This was the forerunner of the National Dysautonomia Research Foundation. He was also a charter member of the American Society of Hypertension and the American College of Clinical Pharmacology.
The Dysautonomia Foundation presented him with their lifetime achievement award. He was also a member of the Endocrine Society, the American Diabetes Association and the International Society of Hypertension. From 1956 to 1996 he had continuous support from the National Institutes of Health for his research, and during most of those years presented his work at the annual meetings of the Endocrine Society.
Streeten was a mentor for generations of medical students, house officers, and fellows, many of whom have distinguished themselves in the field of endocrinology, and was a role model for patient-oriented researchers. To the end, he was a master diagnostician, the consultant for the most perplexing patients.
In addition to his scientific accomplishments, Streeten was a much loved physician because of his warmth and kindness to patients. He truly listened to them and spared no effort in trying to analyze and resolve their problems. In the process, patients learned a great deal about their diseases. For many patients, this empathy was a powerful solace in coping with diseases that few physicians were interested in and fewer yet understood. His desire to help these patients helped guide his clinical investigations for over 40 years.
Streeten leaves behind him his wife, Barbara Ward Streeten, whom he met and married during his first year in Boston. They had a very happy life together for 48 years, with shared interests in medicine and research, and a much-loved family of three children. His daughter, Elizabeth followed her father into academic endocrinology. He was a wonderful family man, full of energy and optimism and intensely interested in all of the activities of his two sons, daughter and seven grandchildren. They had many adventurous trips together, the last most memorable one to visit Streeten's previous home and some game parks in South Africa, two months before he died so unexpectedly.
(Volume XI, page 562)
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