A brief case presentation makes the point that completing the physical exam can help establish the reason for neonatal cholestasis (J Pediatr 2014; 164: 939).

The authors present a 2-month old with cholestasis who had a micropenis with a length of 1 cm (a stretched length of <2 cm [mean -2.5 SD]) and ultimately was diagnosed with hypopituitarism which has been associated with neonatal hepatitis.  “Low thyroid and cortisol levels may impair bile acid synthesis, bile acid secretion and/or bile flow.”  Hormone replacement is associated with improvement in 10 weeks and complete resolution in 3-9 months.

It is worth noting that the authors decided, despite the physical exam findings that  a liver biopsy wa indicated.  Given the likelihood of hypopituitarism, many practitioners may have opted for a HIDA scan to exclude biliary atresia.

Take-home message:  Don’t forget to check the genital exam in jaundice newborns.