Immunotherapy-induced endocrinopathies remain an adverse risk factor for patients undergoing PD-1/PD-L1 and CTLA-4 target immunotherapy treatment. Immunotherapy works by boosting the immune system to target, bind and block tumor receptors that would otherwise allow the cells to camouflage. This paper focuses on thyroid dysfunction, adrenal insufficiency, diabetes mellitus, and hypophysitis, and specifically the clinical presentation, diagnostic approaches, and management of each. All four endocrinopathies often present with generalized symptoms and, therefore, are commonly misdiagnosed. Healthcare professionals must closely monitor symptoms through laboratory testing and, when necessary, diagnostic imaging to appropriately diagnose and treat endocrinopathies. Thyroid dysfunction and adrenal insufficiency are often debated on immunotherapy hold/discontinuation. However, treatment of grade 3–4 diabetes mellitus and hypophysitis results in holding treatment until immune function prognosis decreases or returns to normal. Overall, ongoing research and clinical trials are needed to understand the varying effects of immunotherapy-induced endocrinopathies. Healthcare professionals should always consider patient symptoms, laboratory results and diagnostic imaging to ensure endocrinopathies are not missed and patients receive optimal care.

Adrenal gland metastases from malignant melanoma are a common but poorly characterised condition. Their lack of consistent clinical features and poor response to immune checkpoint inhibitors pose a significant diagnostic and therapeutic challenge to practitioners. This case report describes a 78-year-old male with no prior history of melanoma presenting with nonspecific abdominal symptoms and unintentional weight loss who was found to have undifferentiated bilateral adrenal gland metastases from malignant melanoma. Despite ongoing investigations, the primary site of the adrenal gland metastases remained unknown, prompting the consideration of primary adrenal melanoma as a diagnosis. The patient underwent four cycles of treatment with immune checkpoint inhibitors, nivolumab and ipilimumab, followed by maintenance therapy and subsequent adrenal metastasectomy. Despite therapeutic efforts, the patient’s tumour was resistant to treatment and became undifferentiated. The patient continued with palliative care until his death, more than three years after the onset of symptoms. The clinical features, pathophysiology, diagnosis, treatment, and prognosis of this patient’s disease are discussed in detail to help inform the management of similar cases.

Introduction: Breast cancer affects over 25,000 women annually in Canada and has seen improved survival rates due to advances in screening and treatment. However, cardiotoxic therapies including anthracyclines and trastuzumab have made cardiovascular disease a leading cause of death among survivors. Baseline left ventricular ejection fraction is a reliable predictor of heart failure, and various guidelines recommend pretreatment cardiac imaging; however, its utility is largely based on expert opinion. Methods: This retrospective cohort study analyzed 93 breast cancer patients treated at a single cancer centre in Northwestern Ontario between 2012 and 2017 to determine the yield (defined as imaging leading to clinically actionable changes in care) of imaging. Results: Patients were grouped by treatment regimen: trastuzumab-only (cohort A, n = 3, mean age = 73.55 ± 9.90), anthracycline-only (cohort B, n = 60, mean age = 58.83 ± 9.83), and combination therapy with both trastuzumab and anthracyclines (cohort C, n = 30, mean age = 59.37 ± 10.91). Due to the very small sample size in cohort A, findings are presented for qualitative insight only. Cohort B had the highest imaging yield (13.33%), while cohorts A and C showed lower yields (7.14% and 4.17%) with more frequent imaging. Predictors of higher yield varied, with cohort B identifying the most, including diabetes and coronary artery disease. Conclusions: These findings underscore the need for targeted cardiac imaging to optimize resource allocation and patient outcomes, particularly in resource-limited settings such as Northwestern Ontario. Subsequent investigations should seek to stratify proactive versus reactive interventions, evaluate outcomes, refine imaging guidelines, and gather more data on patients receiving trastuzumab.

Every year, more than 25,000 Canadian women are diagnosed with breast cancer

Invasive Haemophilus influenzae disease, particularly caused by serotype a (Hia) and non-typable (NTHi) strains, is prevalent in northwestern Ontario, Canada and can cause serious illness. This study reviewed epidemiological data for seven cases of invasive H. influenzae disease that presented over a 20-month period at the regional hospital serving northwestern Ontario. One pediatric and six adult cases with the following blood isolates were reported: 2 Hia, 2 NTHi, 2 serotypes f (Hif) and 1 serotype e (Hie). These findings demonstrate the consistent presence of Hia and NTHi as causes of serious disease in the region, preferentially affecting adults. Most patients in this cohort presented with pneumonia (71.4%) or bacteremia (57.1%). Two unique adult cases, bacteremia caused by Hie and epiglottitis secondary to Hif, were reported. This study highlights the need for ongoing surveillance of invasive H. influenzae disease in the region. The continuing presence of Hia supports introducing a new Hia vaccine, which is undergoing clinical trials in Canada, for immunization of groups at risk of invasive Hia disease.