**Core Concept**
Hypercalcemia is a condition characterized by elevated serum calcium levels, which can result from various etiologies including primary hyperparathyroidism, malignancy, vitamin D toxicity, and others. The pathophysiology of hypercalcemia involves increased calcium absorption from the gut, increased bone resorption, or decreased renal excretion.

**Why the Correct Answer is Right**
Hypercalcemia can manifest with a range of clinical features, including neuromuscular symptoms such as weakness, fatigue, and muscle cramps. Additionally, patients may experience gastrointestinal symptoms like nausea, vomiting, and constipation. Furthermore, hypercalcemia can lead to nephrocalcinosis and renal impairment. However, one key feature that is not typically associated with hypercalcemia is **hypotension**. In fact, hypercalcemia often leads to hypertension due to vasoconstriction and increased cardiac output.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because hypercalcemia can indeed cause neuromuscular symptoms like weakness, fatigue, and muscle cramps.
**Option C:** This option is incorrect because hypercalcemia can lead to gastrointestinal symptoms like nausea, vomiting, and constipation.
**Option D:** This option is incorrect because hypercalcemia can indeed cause nephrocalcinosis and renal impairment.

**Clinical Pearl / High-Yield Fact**
It's essential to remember that hypercalcemia can mimic various other conditions, including acute pancreatitis, which may present with similar symptoms like abdominal pain and nausea. A high index of suspicion and careful evaluation are necessary to diagnose hypercalcemia correctly.

**Correct Answer: D. Hypotension**