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 Pituitary tumors. Pituitary tumors can cause hyperprolactinemia via two mechanisms; prolactinomas secrete excess PRL, while large nonfunctioning pituitary adenomas can cause pituitary stalk compression, disrupting the communication between the dopaminergic neurons that control PRL secretion and lactotrophs. Pituitary stalk disruption can also occur following pituitary surgery or trauma. Hyperprolactinemia due to pituitary stalk disruption is usually modest, with levels rarely exceeding 150 μg/L (~3000 mIU/L), whereas prolactinomas can be associated with levels > 1000 μg/L (~20000 mIU/L) [12,13].

 Renal failure. Hyperprolactinemia can occur in up to 30% of patients with chronic kidney disease, most likely due to decreased renal clearance of PRL or impairment of dopamine’s regulatory action by uremia [14].Table 14.1 Medications which cause hyperprolactinemia [10,11].AntipsychoticsPhenothiazines: chlorpromazine, trifluoperazine, fluphenazine, perphenazineThioxanthenes: thiothixeneButyrophenonesAtypical antipsychotics: risperidone, olanzapine, quetiapine AntidepressantsTricyclic antidepressants: imipramine, amitriptylineMAO inhibitors: tranylcypromineSSRIs: fluoxetine, paroxetine, citalopram, fluvoxamine Gastrointestinal medicationsMetoclopramideDomperidoneCimetidine Antihypertensivesα‐methyldopaReserpineVerapamil Estrogens Opioids

 Primary hypothyroidism. Primary hypothyroidism can occasionally cause a mild increase in PRL, mediated primarily by increased secretion of TRH [5].

 Polycystic ovary syndrome (PCOS). Early literature documented mild hyperprolactinemia in up to 30% of women with PCOS [15]. However more recent studies have shown a less frequent association of these disorders, with rigorous etiological approaches detecting other causes to account for the hyperprolactinemia [16,17]. These findings suggest hyperprolactinemia found in PCOS is due either to transient increase in serum prolactin levels, macroprolactinemia or other etiologies, and the two conditions are not linked [16,17].

  Liver cirrhosis. Hyperprolactinemia has been documented in up to 20% of patients with liver cirrhosis [18]. The precise pathophysiological mechanism is unknown, but hyperprolactinemia in this setting is seen as a marker of poor prognosis [18].

 Chest wall lesions and trauma. The precise mechanism for hyperprolactinemia following chest wall trauma remains unclear, but it has been suggested that stimulation of the intercostal nerves from T2 to T6 causes PRL release [19].

 Idiopathic hyperprolactinemia. This is when no specific cause of hyperprolactinemia can be identified. Some cases may have a prolactinoma that is too small to be identified by magnetic resonance imaging (MRI) scanning. In others, PRL may return to normal in due course with no specific intervention.