When Robert “Bob” Preston, 72, found a bump on his scalp and discussed it with his primary care provider (PCP), Elbert Acosta II, MD, a biopsy was performed.
Bob, who lives in New Castle, was diagnosed with squamous cell carcinoma, and he was referred to Diwakar Davar, MD, a medical oncologist and hematologist at UPMC Hillman Cancer Center in Shadyside.
Dr. Davar recommended Bob start an immunotherapy clinical trial of pembrolizumab (Keytruda). He began the trial, taking the medicine before and after surgery to remove the tumor in December 2023 at UPMC Shadyside.
Bob then began radiation treatment under the care of Yvonne Mowery, MD, PhD, a radiation oncologist at UPMC Hillman Cancer Center in Shadyside.
After five sessions of radiation therapy and 16 infusions of immunotherapy, Bob started to develop side effects, starting with fatigue. Further testing showed that his thyroid levels were low.
In 2024, Bob developed tenesmus, a frequent urge to go to the bathroom without being able to do so. He was referred to a gastroenterologist and next, Marc Brozovich, MD, a colorectal surgeon at UPMC St. Margaret, to treat his tenesmus.
Later, Bob’s muscles began aching, and he experienced more gastrointestinal symptoms.
“I always felt bloated, had stomach problems, and no appetite,” says Bob, who adds that he lost 23 pounds in 2025. “We couldn’t figure out what was wrong – even with a scope and a colonoscopy.”
A Rare Side Effect
Bob’s PCP ordered more bloodwork. After reviewing his results, Adam Slivka, MD, PhD, a gastroenterologist at UPMC Digestive Health Care, noticed Bob’s cortisol was low and referred him to endocrinologist Stephanie Hakimian, MD.
She tested his cortisol, but the results were normal. Bob says steroid injections for his neck pain may have played a part in that reading.
In December, the flu combined with low blood pressure caused Bob to pass out, leading to a visit to the nearby emergency department at UPMC Jameson. After receiving a shot of hydrocortisone, Bob’s blood pressure returned to a normal level.
He had bloodwork done again, and it showed that his cortisol was low. Bob was then referred to Neha Mehrotra, MD, an endocrinologist at UPMC Center for Diabetes and Endocrinology in New Castle, who leads a clinic for immunotherapy patients.
Bob was diagnosed with a rare side effect from immunotherapy called secondary adrenal insufficiency, and was prescribed hydrocortisone.
“By March, I started putting weight back on, and I was feeling good,” says Bob, who owns 10 car dealerships and spends part of the year in Florida.
He returns for a visit in December and will continue taking hydrogen cortisol.
“I can’t say enough about my doctors. Everybody was fantastic and impressive,” Bob adds.
To recognize his doctors, he donated $15,000 in their honor.
“My care team at UPMC was great, including PA Darcy Ploucha, and the UPMC Hillman nurses and others I met in the hospital were unbelievably kind,” he says.
Bob hopes that by sharing his story, he can help other patients who are on similar medications recognize the warning signs of adrenal insufficiency.
Bob’s treatment and results may not be representative of other cases.
