Guanylyl cyclase catalyzes the synthesis of cGMP from GTP. Guanylyl cyclase exists in both a membrane-bound and soluble form. The membrane-bound form is a plasma membrane receptor, while soluble forms of guanylyl cyclase undergo activation by nitric oxide. Nitric oxide then functions as a second messenger, amplifying the signal intracellularly. In this review, we discuss the biochemistry, function, and clinical relevance of guanylyl cyclase.