Which of the following condition(s) is/are associated with hyperprolactinemia?

a. Chronic renal failure

b. Exogenous estrogen administration

d. Cirrhosis 

Elevated serum prolactin levels do not always indicate the presence of a pituitary tumor. Important alternative causes are chronic renal failure, hypothyroidism, various drugs including phenothiazines, tricyclic antidepressants, exogenous estrogen, opiates, reserpine, verapamil and others. In addition, hepatic disease, pregnancy and a variety of pituitary and hypothalamic lesions cause hyperprolactinemia. If the prolactin level is over 150 ng/ml, a pituitary tumor is almost invariably the cause, but often microadenomas produce prolactin levels of less than 100 ng/ml. The size of pituitary tumors has been shown to relate to the degree of prolactin elevation, which may reach into the thousands of nanograms per milliliter. There are no reliable provocative tests to differentiate prolactinomas from other causes of hyperprolactinemias, so the diagnosis relies on ruling out other causes and imaging of the adenoma.