A 48-year-old man presents to the endocrinology clinic with progressive facial changes over the past 8 years. On examination, he has frontal bossing, enlarged nose and lips, and the feature marked **C** in the diagram (mandibular prognathism) with malocclusion and dental spacing. His serum IGF-1 is markedly elevated at 680 ng/mL (normal: 90–235 ng/mL for his age). An oral glucose tolerance test shows GH remains at 2.8 ng/mL after 2 hours of 75 g glucose load. Pituitary MRI reveals a 1.8 cm sellar mass with suprasellar extension. Which of the following best explains the pathophysiology underlying the mandibular changes marked **C**?
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