Abstract—A 53 year-old female, presented with heaviness in chest since one-week of duration. She was having on and off history of generalized weakness, fatigability, increased frequency of urination. She had no past history of hypertension or diabetes, she attained menopause 1 year back. Her lifestyle is very sedentary. Physical examination: obese woman. Height 165 cm, weight 82 kg, BMI of 32 kg/m 2 . Pulse rate: 98/min; regular, normal volume, no radio-radial, nor radio-femoral delay. Blood pressure: 160/110 mmHg in right and left upper limb. She was having black velvety hyperpigmentation of the skin especially on the neck possibly acanthosis nigricans, apart from this patch, rest of the systemic examination is normal. Her random blood sugar was 210 mg/dL as measured by Glucometer. Patient was diagnosed as metabolic syndrome. Patient was counselled and explained she is having diabetes mellitus, hypertension, and she has all the signs of metabolic syndrome. Patient was started on life style modification, diet modification, Pharmacotherapy, lipidemic drugs.