Addison's disease and cocaine use

This is almost more of an intellectual exercise than a true medical question, please let me know if there is a better place to ask this.

My (31M) male friend with Addison's disease and hypothyroidism on daily hydrocortisone and synthroid x 1 year (since his AD Diagnosis) took cocaine 2 nights ago and noticed that it didn't have the same effect that it had 2-3 months ago; while in the past it helped him feel very energetic, getting him to dance and rave, this time around he felt physically completely drained and unable to move. During the day prior to the cocaine trip he took a stress dose of steroids (total of 2x his daily dose) to anticipate the night of raving. He recovered fine from the trip but then promptly asked me (a medical student) for my opinion, to understand what might have happened and how and whether he can use more safely in the future. This friend uses cocaine maybe 4 times a year.

I couldn't find any literature on AD and cocaine, but from these articles : https://www.ncbi.nlm.nih.gov/pubmed/24852417 ; and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1821355/?fbclid=IwAR018HvfiI6OwOOCtS8ijrUvn_lhRWLKaIyK0KLOYiB9ebcK6wBnWT0c_yI sent to me by this friend in question we've been able to understand that in AD the usual HPA upregulation by cocaine may be blocked due to adrenal insufficiency, resulting in elevated CRF-ACTH but no increase in cortisol as a response. I figured this may explain his flat exhausted state.

Now, I know someone doesn't need to have AD for there to be concerns about risks of cocaine use; I'm aware it can cause vasospasm and MI in healthy young men, not to mention its abuse potential. However, my additional concern is that his cardiac risk is elevated twofold - first, due to the arrhythmogenic effects of cocaine itself, and second, due to the potential electrolyte imbalances associated with a state of having insufficient adrenal hormones. My other concern is that the risk of psychosis increases, especially considering the prodaminergic effects of cocaine combined with the psychotic effects of stress dosed steroids. These combined effects lead me to tell him, right off the bat, that I would recommend stopping cocaine use given his AD.

However, for the intellectual exercise, I came this subreddit to know if anyone has any insight as to the pharmacology and endocrinology of what a person with AD may experience on cocaine and the specific risks they may incur, and if there are any harm avoidance strategies to propose. I am inclined to recommend continuation of stress doses, but I'm concerned about aftereffects of this. His physician responded with a simple 'don't do cocaine' and declined to engage in the conversation, but out of curiosity's sake I came here to see if anyone wanted to indulge in this exercise.

TL;DR: What happens to a person with Addison's disease if they take cocaine, what are their specific risks, and how can they best be mitigated?

This is almost more of an intellectual exercise than a true medical question, please let me know if there is a better place to ask this.My (31M) male friend with Addison's disease and hypothyroidism on daily hydrocortisone and synthroid x 1 year (since his AD Diagnosis) took cocaine 2 nights ago and noticed that it didn't have the same effect that it had 2-3 months ago; while in the past it helped him feel very energetic, getting him to dance and rave, this time around he felt physically completely drained and unable to move. During the day prior to the cocaine trip he took a stress dose of steroids (total of 2x his daily dose) to anticipate the night of raving. He recovered fine from the trip but then promptly asked me (a medical student) for my opinion, to understand what might have happened and how and whether he can use more safely in the future. This friend uses cocaine maybe 4 times a year.I couldn't find any literature on AD and cocaine, but from these articles : https://ift.tt/2MESN7w ; and https://ift.tt/36f3hTe sent to me by this friend in question we've been able to understand that in AD the usual HPA upregulation by cocaine may be blocked due to adrenal insufficiency, resulting in elevated CRF-ACTH but no increase in cortisol as a response. I figured this may explain his flat exhausted state.Now, I know someone doesn't need to have AD for there to be concerns about risks of cocaine use; I'm aware it can cause vasospasm and MI in healthy young men, not to mention its abuse potential. However, my additional concern is that his cardiac risk is elevated twofold - first, due to the arrhythmogenic effects of cocaine itself, and second, due to the potential electrolyte imbalances associated with a state of having insufficient adrenal hormones. My other concern is that the risk of psychosis increases, especially considering the prodaminergic effects of cocaine combined with the psychotic effects of stress dosed steroids. These combined effects lead me to tell him, right off the bat, that I would recommend stopping cocaine use given his AD.However, for the intellectual exercise, I came this subreddit to know if anyone has any insight as to the pharmacology and endocrinology of what a person with AD may experience on cocaine and the specific risks they may incur, and if there are any harm avoidance strategies to propose. I am inclined to recommend continuation of stress doses, but I'm concerned about aftereffects of this. His physician responded with a simple 'don't do cocaine' and declined to engage in the conversation, but out of curiosity's sake I came here to see if anyone wanted to indulge in this exercise.TL;DR: What happens to a person with Addison's disease if they take cocaine, what are their specific risks, and how can they best be mitigated? https://ift.tt/eA8V8J https://ift.tt/2F6sm6B