Cortisol (CORT), also known as stress hormone, plays a vital role in physiological processes such as electrolyte and fluid balance, cardiovascular homeostasis, carbohydrate, protein and lipid metabolism, immune and inflammatory responses, and sexual development and reproduction. Cortisol levels are influenced by various physiological factors such as race, age, circadian rhythm, seasonality, exercise and pregnancy. Also, some stressful conditions including isolation or transport, among others, modify levels of this hormone in the body. Excesses or deficiencies of cortisol cause important clinical problems such as Cushing's and Addison's syndromes, which contribute substantially to morbidity in equine medicine. Thus, in this review, we will develop the mechanisms of synthesis and regulation, as well as the physiological factors involved and the most important diseases related to the alteration of cortisol secretion in horses and foals.