Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 3 1 2018 08 26 e9 e9 Tina Deihim Internal Medicine Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Nasim KhajaviRad Internal Medicine Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Abaszadeh Internal Medicine Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sahar Karimpour Reihan Internal Medicine Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2018 07 26 2018 08 21 Introduction: Ectopic adrenocorticotropic hormone (ACTH) syndrome is recognized by edema, proximal muscle weakness, hypertension, diabetes and skin hyperpigmentation. This syndrome is mainly associated with malignancies. Case presentation: A 43-year-old woman came to our hospital with a history of new-onset diabetes, hypertension, edema and facial hyperpigmentation from four months before. Upon admission, she had alkalosis, hypokalemia, mild hypertension and low-grade fever. Due to abdominal pain, an abdominal ultrasound was performed, which revealed common bile duct (CBD) and pancreatic duct dilation. The abdominopelvic computed tomography (CT) scan showed a poorly-enhancing mass in the periampullary region. Conclusion: The patient's facial hyperpigmentation and hypokalemia appear to have been due to ACTH ectopic syndrome as a result of periampullary cancer. https://fem.tums.ac.ir/index.php/fem/article/view/98 https://fem.tums.ac.ir/index.php/fem/article/download/98/84