Others that we think of less frequently include antidepressants, such as MAO inhibitors and tricyclics. The antiemetics that effect dopamine metabolism such as Reglan can cause hyperprolactinemia. In addition, antihypertensives that act through central mechanisms such as reserpine and methyl-dopa as well as calcium channel blockers may cause hyperprolactinemia. And, of course, estrogens are known to induce hyperprolactinemia. However, it is extremely uncommon that estrogens in dosages contained in either oral contraceptives or hormone replacement therapy would elevate prolactin into the grossly abnormal range.
Hypothalamic disease can also cause hyperprolactinemia.
These are particularly important causes of hyperprolactinemia to exclude as they may include other life-threatening pathology. Hypothalamic tumors, especially craniopharyngiomas, can interfere with the normal prolactin inhibition and cause circulating hyperprolactinemia. Infiltrating diseases of the hypothalamus may also present what hyperprolactinemia. Most notably, sarcoid and histiocytosis are occasionally found. Central pituitary disease is the most common cause with prolactinomas being extremely frequent.