Desmopressin-Responsive Nocturnal Enuresis Following Guanfacine Treatment in a Child with ADHD

The documents a unique instance of guanfacine-induced secondary nocturnal enuresis in an 8-year-old boy diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). In this case, an 8-year-old boy with ADHD and a history of Ventricular Septal Defect surgery was treated with guanfacine XR 1 mg/day. Within three days, the boy experienced intermittent nocturnal enuresis. Despite partial ADHD symptom improvement with a dose increase to 2 mg/day, nocturnal enuresis worsened (up to four times a week). Subsequent dose reductions and additions of desmopressin partially alleviated enuresis symptoms. Notably, ADHD symptoms remitted with a dose escalation to 3 mg/day but were accompanied by increased enuresis frequency. Significant improvement was achieved through dose adjustments and the introduction of desmopressin, highlighting a potential management strategy for this side effect.