Immunotherapy has transformed the outlook for people like me living with advanced melanoma. It’s given hope where once there was very little. It’s extended lives, and in many cases—like mine—it has delivered something extraordinary:

Time

But alongside that hope can come a different kind of challenge. One that isn’t always talked about enough.

Adrenal insufficiency.

Drugs like nivolumab and ipilimumab work by supercharging the immune system—essentially taking the brakes off so it can recognise and attack cancer cells.

For many of us, that’s life-saving.

But sometimes, that same immune system gets a little confused. Instead of just targeting cancer, it can begin to attack healthy parts of the body too.

One of those targets can be your hormone system.

When the Body Turns on Itself

Adrenal insufficiency happens when your body can’t produce enough cortisol—a hormone that is absolutely vital for survival.

This can happen in two main ways:

Direct damage to the adrenal glands, similar to Addison’s disease Or, more commonly with immunotherapy, inflammation of the pituitary gland—a condition called Hypophysitis

The pituitary is like the conductor of an orchestra. When it stops sending the right signals, everything downstream—especially cortisol production—starts to falter.

The Symptoms That Can Sneak Up on You

Adrenal insufficiency doesn’t always arrive dramatically. In fact, it often creeps in quietly.

You might feel:

Exhausted beyond anything you’ve known before. Dizzy or lightheaded. Sick, with little appetite. Weak, both physically and mentally.

It’s easy to dismiss these symptoms—especially when you’re already going through cancer treatment. You tell yourself it’s “just part of it.”

But sometimes, it’s something more.

The Day Things Change

For some, adrenal insufficiency is picked up in routine blood tests. For others, it comes to light when things suddenly worsen.

There is something called an adrenal crisis—a moment when cortisol levels drop dangerously low. It can be frightening, serious, and requires urgent treatment.

It’s one of those moments where knowledge really is power.

Living With It: A New Normal

The reality is, for many of us, adrenal insufficiency doesn’t just go away.

Instead, it becomes part of life.

Daily steroid replacement—often with hydrocortisone—steps in to do the job your body no longer can. You learn about “sick day rules,” adjusting your dose when your body is under stress. You may carry an emergency injection, just in case.

It sounds daunting at first.

But like so much in this journey—you adapt.

The Perspective That Matters

Here’s the truth.

Immunotherapy may have taken something away—but it also gave something back.

For me, and for many others, it has given life.

And if managing adrenal insufficiency is part of the price, then it’s a price worth understanding, preparing for, and living with as fully as possible.

A Message to Others on This Path

If you’re going through immunotherapy and something doesn’t feel right—listen to your body.

Ask questions. Push for blood tests. Trust your instincts – you know your own body and fitness levels better than anyone.

Because catching adrenal insufficiency early can make all the difference.

And if you’ve already been diagnosed—know this:

You’re not alone in it.

One Life… Live It

This journey isn’t just about surviving cancer. It’s about learning how to live again—fully, consciously, and with purpose—even when the road changes direction.

Adrenal insufficiency might be part of your story.

But it doesn’t define the ending.