<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 45-year-old man comes to the physician for the evaluation of difficulty swallowing that has worsened over the past year. He also reports some hoarseness and generalized bone, muscle, and joint pain. During the past six months, he has had progressive constipation and two episodes of kidney stones. He also reports recurrent episodes of throbbing headaches, diaphoresis, and palpitations. He does not smoke or drink alcohol. He takes no medications. His vital signs are within normal limits. Physical examination and an ECG show no abnormalities. Laboratory studies show calcium concentration of 12 mgdL, phosphorus concentration of 2 mgdL, alkaline phosphatase concentration of 100 UL, and calcitonin concentration of 11 pgmL N 8.8. Ultrasonography of the neck shows hypoechoic thyroid lesions with irregular margins and microcalcifications. Which of the following is the most likely underlying cause of this patients condition?? A: Mutated NF1 gene, B: Exposure to ionizing radiation, C: Deleted VHL gene, D: Altered RET proto-oncogene expression, E: Disrupted menin protein function,  <response>: Based on the patients symptoms of difficulty swallowing, hoarseness, bonemusclejoint pain, constipation, kidney stones, headaches, sweating, palpitations, elevated calcium and calcitonin levels, and thyroid nodules on ultrasound, the most likely diagnosis is hyperparathyroidism due to a parathyroid adenoma. The parathyroid glands regulate calcium homeostasis by secreting parathyroid hormone PTH. Overproduction of PTH leads to hypercalcemia. This causes the constellation of neuromuscular, gastrointestinal, renal, and skeletal symptoms described. Elevated serum calcium and PTH levels confirm the diagnosis. Thyroid nodules can sometimes co-occur but are not the primary pathology.The other answer choices describe genetic conditions that may present with some shared features, but do not explain the full clinical picture:A NF1 - presents with neurofibromas, not hypercalcemia B Radiation exposure - could cause thyroid nodules but not hyperparathyroidismC VHL - associated with tumors in specific locations, not hypercalcemiaD RET proto-oncogene - could cause thyroid nodules but not hyperparathyroidismE Menin - causes endocrine tumors but not hypercalcemiaD: Altered RET proto-oncogene expression 