Step 1: Define the term. Hypertrophy is an increase in the size of cells, which results in an increase in the size of the affected tissue or organ. There is no increase in the number of cells. The enlargement happens without cell division, so a hypertrophied organ simply has bigger cells, not new ones.
Step 2: Mechanism. The increase in cell size is driven by the synthesis of more structural proteins and organelles. Nuclei of hypertrophied cells often have a higher DNA content because the cells arrest in the cell cycle without completing mitosis. The most common stimulus is increased workload.
Step 3: Examples. Permanent (non-dividing) tissues such as the myocardium and skeletal muscle classically undergo hypertrophy, for example left ventricular hypertrophy in systemic hypertension.
Step 4: Why the other options are wrong. Increase in cell number (option a) describes hyperplasia, not hypertrophy. Decrease in cell number (option c) is hypoplasia or involution, and decrease in cell size (option d) is atrophy. Hence the correct answer is increase in cell size.