atrophy

atrophy, decrease in size of a body part, cell, organ, or other tissue. The term implies that the atrophied part was of a size normal for the individual, considering age and circumstance, prior to the diminution. In atrophy of an organ or body part, there may be a reduction in the number or in the size of the component cells, or in both.

Certain cells and organs normally undergo atrophy at certain ages or under certain physiologic circumstances. In the human embryo, for example, a number of structures are transient and at birth have already undergone atrophy. The adrenal glands become smaller shortly after birth because an inner layer of the cortex has shrunk. The thymus and other lymphoid tissues atrophy at adolescence. The pineal gland tends to atrophy about the time of puberty; usually calcium deposits, or concretions, form in the atrophic tissue. The widespread atrophy of many tissues that accompanies advanced age, although universal, is influenced by changes of nutrition and blood supply that occur during active mature life.

The normal cyclic changes of female reproductive organs are accompanied by physiologic atrophy of portions of these organs. During the menstrual cycle, the corpus luteum of the ovary atrophies if pregnancy has not occurred. The muscles of the uterus, which enlarge during pregnancy, rapidly atrophy after the delivery of the child, and after completion of lactation the milk-producing acinar structures of the breast diminish in size. After menopause the ovaries, uterus, and breasts normally undergo a degree of atrophic change.

Whole body atrophy

Atrophy in general is related to changes in nutrition and metabolic activity of cells and tissues. A widespread or generalized atrophy of body tissues occurs under conditions of starvation, whether because food is unavailable or because it cannot be taken and absorbed because of the presence of disease. The unavailability of certain essential protein components and vitamins disturbs the metabolic processes and leads to atrophy of cells and tissues. Under conditions of protein starvation, the body protein is broken down into constituent amino acids, which serve to provide energy and help maintain the structure and cells of the most essential organs. The brain, heart, adrenal glands, thyroid gland, pituitary gland, gonads, and kidneys show less atrophy, relatively, than the body as a whole, whereas the fatty stores of the body, liver, spleen, and lymphoid tissues diminish relatively more than the body as a whole. The brain, heart, and kidneys, organs with abundant blood supply, appear to be the least subject to the wasting effects of starvation.

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Associated with the widespread atrophy due to lack of protein is the atrophy of certain tissues that is caused by deficiencies of specific vitamins. Atrophic changes of the skin increase because of the lack of vitamin A, and atrophy of muscle increases because of the unavailability of vitamin E.

After a growth period of human metabolism, there sets in a gradual decline: slow structural changes other than those due to preventable diseases or accidents occur. Aging eventually is characterized by marked atrophy of many tissues and organs, with both a decline in the number of cells and an alteration in their constitution. This is reflected eventually in the changed, diminished, or lost function characteristic of old age and eventuates in death. The changes in senescence are affected by both inherited constitution and environmental influences, including disease and accident.

Atrophic changes of aging affect almost all tissues and organs, but some changes are more obvious and important. Arteriosclerosis—the thickening and hardening of arterial walls—decreases the vascular supply and usually accentuates aging processes.

Atrophy in old age is especially noticeable in the skin, characteristically flat, glossy or satiny, and wrinkled. The atrophy is caused by aging changes in the fibres of the true skin, or dermis, and in the cells and sweat glands of the outer skin. Wasting of muscle accompanied by some loss of muscular strength and agility is common in the aged. In a somewhat irregular pattern, there is shrinkage of many individual muscle fibres as well as a decrease in their number. Other changes have been observed within the muscle cells.

Increase of the pigment lipofuscin is also characteristic in the muscle fibres of the heart in the aged in a condition known as brown atrophy of the heart. Wasting of the heart muscle in old age may be accompanied by increase of fibrous and fatty tissue in the walls of the right side of the heart and by increased replacement of elastic tissue with fibrous tissue in the lining and walls of coronary arteries within the heart muscle. Abnormal deposits of the protein substance amyloid also occur with greater frequency in the atrophic heart muscle in old age.

Atrophy of the liver in the aged is also accompanied by increased lipochrome pigment in the atrophied cells.

The bones become progressively lighter and more porous with aging, a process known as osteoporosis. The reduction of bone tissue is most marked in cancellous bone—the open-textured tissue in the ends of the long bones—and in the inner parts of the cortex of these bones. In addition to changes in and loss of osteocytes, or bone cells, there is decreasing mineralization, or calcium deposit, with enhanced fragility of the bones.

Atrophy of the brain in old age is shown by narrowing of the ridges, or gyri, on the surface of the brain and by increased fluid in the space beneath the arachnoid membrane, the middle layer of the brain covering. There is shrinkage of individual neurons, with an increase in their lipochrome pigment content, as well as a decrease in their number. Sometimes the nerve fibrils have degenerated, and deposits called senile plaques may be found between the neurons, particularly in the frontal cortex and hippocampus (a ridge in the wall of an extension, or horn, of the lateral ventricle, or cavity, of the brain). Similar atrophic changes are seen in the brain in Alzheimer disease, a condition of unknown cause most likely to occur in older patients. The mental deterioration (senile dementia) of the aged is the clinical manifestation of these changes. Senile atrophy may be increased and complicated by the presence of arteriosclerosis.

Simmonds disease is a chronic deficiency of function of the pituitary gland, a form of hypopituitarism, that leads to atrophy of many of the viscera, including the heart, liver, spleen, kidneys, thyroid, adrenals, and gonads. The disease results in emaciation and death if left untreated.

A destructive or atrophic lesion affecting the pituitary gland with loss of hormones leads to atrophy of the thyroid gland, adrenal glands, and gonads and in turn brings atrophic changes to their target organs and the viscera. The decrease in size of the endocrine glands may be extreme.