HYPERTROPHY

DEFINITION
Hypertrophy refers to an increase in
the size of cells resulting in an
increase in the size of the organ.
Thus the hypertrophied organ has no
new cells, just large cells. The
increased size of the cells is due not
to cellular swelling but to the
synthesis
of
more
structural
components.

CAUSES OF HYPERTROPHY

Hormonal stimulation

Increased work load

Increased functional demand

TYPES OF HYPERTROPHY
Hypertrophy is of two types:

Physiological Hypertrophy

Pathological Hypertrophy

STIMULUS FOR HYPERTROPHY

The environmental change that produces

hypertrophy of striated muscle, appears
mainly to be increased workload.

In the heart, the stimulus is high blood

pressure.

In skeletal muscles, heavy work.

PHYSIOLOGICAL HYPERTROPHY

Physiologic hypertrophy occurs apart from disease.

The best example is the pregnant uterus.
The growth of uterus during pregnancy involves
both hypertrophy and hyperplasia.
Cellular hypertrophy is stimulated by estrogen
which results in increased synthesis of smooth
muscle proteins and increase in cell size.
This is an example of physiologic hypertrophy
effected by hormonal stimulation.
Breast enlargement during pregnancy is also due
to estrogen stimulation.

ADAPTIVE HYPERTROPHY

Adaptive hypertrophy is exemplified by

skeletal muscle enlargement in the avid
weight lifter.
It is also demonstrated by cardiac
enlargement in the chronically
hypertensive patient.
The striated muscle cells in both the heart
and skeletal muscles are most capable of
hypertrophy. It is perhaps because they
cannot adapt by mitotic division and
formation of new more cells.

ADAPTATION
Synthesis of more proteins and
filaments occur, achieving a balance
between the demand and the cells
functional capacity.

PATHOLOGICAL HYPERTROPHY

Left ventricle hypertrophy due to systemic

hypertension.
Right ventricle hypertrophy due to
pulmonary hypertension.
Demonstration of adaptive hypertrophy of
cardiac muscles.
Hypertrophy of uterine muscles under the
influence of estrogen secreted by ovarian
tumors.

CARDIAC HYPERTROPHY
Lt. ventricle

Heart wt upto 350g

Lt. ventricle

Heart wt upto 400-650g

MECHANISM OF CARDIAC
HYPERTROPHY
The mechanisms of cardiac muscle
hypertrophy
involve
many
signal
transduction Pathways leading to the
induction of number of genes, which in
turn stimulate synthesis of numerous
cellular proteins

Example : Cardiac Hypertension

Mechanical stretch through a stretch

receptor triggers RNA synthesis and protein
production causes hypertrophy.

Increase expression of genes for contractile

proteins as a result of activation of a
adrenergic
receptors
on
surface
of
myocytes.

There may also be a dramatic change in

the cell phenotype in response to
increased external stress.

What ever the exact mechanism of

cardiac
hypertrophy,
it
eventually
reaches
a
limit
beyond
which
enlargement of muscle mass is no
longer able to compensate for the
increased burden and cardiac failure
envies. At this stage, a number of
degenerative changes occur in the
myocardial fibers, of which the most
important are lysis and loss of
myofibrillar contractile elements.

LIMITATINS OF HYPERTROPHY
Hypertrophy cannot manage to occur
beyond certain limits due to: Limitation

of vascular supply to
enlarged fibers.
Diminished oxidative capabilities
of mitochondria
Alteration in protein synthesis and
degradation.

COMPENSATORY HYPERTROPHY

Compensatory hypertrophy is an
increase in size to compensate for loss
tissue. It is best seen in paired organs.
When one kidney is removed or atrophies
because of disease, the remaining kidney
does the work of two and becomes
correspondingly enlarged. There is no
formation of new elements but merely an
increase in size of the existing glomeruli
and tubules.