GH1 and cholestasis: The role of cardiac defects in growth impairment in ALGS has been recognized, which may also be associated with decreased energy and macronutrient intake in this subpopulation.7 Furthermore, higher levels of circulating growth hormone (GH) were found in a small study of children with cholestasis, suggesting GH resistance in these children.11 This hypothesis seems plausible as a follow-up study found no hormonal response to GH administration in 4 children with ALGS and short stature.12