Rationale:Ectopic ACTH-producing pituitary adenoma (EAPA) of the clivus region is extraordinarily infrequent condition and merely a few reports have been reported to date.Patient concerns:The patient was a 53-year-old woman who presented with Cushing-like appearances and a soft tissue mass in the clivus region.Diagnoses:The final diagnosis of clivus region EAPA was established by clinical, radiological and histopathological findings.Interventions:The patient underwent gross total clivus tumor resection via transsphenoidal endoscopy.Outcomes:Half a year after surgery, the patient Cushing-like clinical manifestations improved significantly, and urinary free cortisol and serum adrenocorticotropin (ACTH) returned to normal.Lessons:Given the extreme scarcity of these tumors and their unique clinical presentations, it may be possible to misdiagnose and delayed treatment. Accordingly, it is especially crucial to summarize such lesions through our present case and review the literature for their precise diagnosis and the selection of optimal treatment strategies.