PRL and hyperprolactinemia: In end-stage chronic kidney disease, decreased clearance is the main factor in the elevation of PRL.(19) Alterations in the nerve endings of the chest wall lead to decreased inhibition by dopamine,(20) also observed in liver cirrhosis, which also presents increased estrogen concentrations.(21) Hyperprolactinemia is found in 20-40% of patients with primary hypothyroidism and is caused by the elevation of TRH, a lactotroph secretagogue.