Equine Cushing's disease (ECD) is a chronic progressive disease of the intermediate pituitary gland of older horses. Horses with Cushing's disease often have other health problems, such as laminitis, chronic infections, pseudolactation, and other issues. Diagnosis of ECD is usually based on clinical signs and endocrine tests. Medical management of affected horses is usually a long-term or lifelong commitment. The goal of this article is to review the pathophysiology of ECD, outline diagnostic tests, and present treatment options.