**Core Concept**
Tuberous sclerosis complex (TSC) is a genetic disorder characterized by the growth of non-cancerous tumors in various organs, including the skin, brain, kidneys, and other organs. It is caused by mutations in either the TSC1 or TSC2 genes, leading to the activation of the mammalian target of rapamycin (mTOR) pathway.

**Why the Correct Answer is Right**
Tuberous sclerosis is a complex disorder that affects multiple organ systems. The correct answer is one of the manifestations that is NOT typically associated with TSC. The disorder is known for its hamartomas, which are benign tumors that can occur in various organs. The mTOR pathway plays a crucial role in cell growth and proliferation, and mutations in TSC1 or TSC2 lead to its activation, resulting in the growth of hamartomas.

**Why Each Wrong Option is Incorrect**
**Option A:** Cortical tubers are a hallmark of TSC, particularly in the brain. They are a type of hamartoma that can cause seizures and other neurological problems.
**Option B:** Subependymal giant cell astrocytomas (SEGAs) are a type of tumor that can occur in the brain in individuals with TSC. They are typically benign but can cause problems if they grow large enough.
**Option C:** Renal angiomyolipomas are a type of tumor that can occur in the kidneys in individuals with TSC. They are benign but can cause problems if they grow large enough and bleed.

**Clinical Pearl / High-Yield Fact**
It's essential to remember that TSC can have a wide range of manifestations, and individuals with the disorder may have a combination of different symptoms and findings. A thorough evaluation and genetic testing can help confirm the diagnosis.

**Correct Answer:** D