<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 63-year-old man comes to the physician because of fatigue and muscle cramps for 6 weeks. He also noticed several episodes of tingling around the mouth and in the fingers and toes. He has osteoarthritis of his knees and hypertension. Current medications include ibuprofen and ramipril. He has smoked one pack of cigarettes daily for 35 years. Tapping over the facial nerve area in front of the ear elicits twitching of the facial muscles on the same side of the face. His serum alkaline phosphatase activity is 66 UL. An ECG shows sinus rhythm with a prolonged QT interval. Which of the following is the most likely underlying cause of this patients symptoms?? A: Medication side effect, B: Vitamin D deficiency, C: Ectopic hormone production, D: Destruction of parathyroid glands, E: Albright hereditary osteodystrophyn,  <response>: Based on the information provided, the most relevant details are:- The patient is a 63-year-old man with fatigue, muscle cramps, tingling around the mouth and fingerstoes for 6 weeks. - He has a history of osteoarthritis, hypertension, and smoking.- He is on ibuprofen and ramipril. - He has low serum alkaline phosphatase and QT prolongation on ECG.- Facial twitching is elicited when tapping the facial nerve.The low alkaline phosphatase and symptoms of muscle cramps, tingling, and twitching point towards hypocalcemia. The QT prolongation also supports electrolyte abnormalities. The facial twitching with tapping suggests increased neuromuscular irritability. Given the patients age and history, the most likely cause appears to be hypoparathyroidism leading to hypocalcemia. This fits with the destruction of the parathyroid glands.D: Destruction of parathyroid glands 