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This article or section includes speculation, observations or opinions possibly supported by lore or by Blizzard officials. It should not be taken as representing official lore.
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Info
When Karazhan was first announced, there were rumors that an upside-down version of the tower existed, extending down from the bottom floor, deep underground. Whether or not Blizzard actually plans to implement this 'Lower Karazhan' remains unknown. It is likely that this is a reference to The Last Guardian by Jeff Grubb, a novel which details the last weeks of (living) activity within the tower. Several references are made to an "inverse" of Karazhan which begins at the lowest level and works its way downward, with Medivh's secret chambers lying at the very bottom. It is also possible that this rumour was a nod to the Konami game Castlevania: Symphony of the Night, wherein players could fight through an upside-down version of Dracula's Castle after completing the regular version. There exists a building behind the nearby graveyard in which there is a stair downward towards a locked gate. One could (and may still be able to) go through this gate as a ghost and explore the large area beyond. This is likely to play a part in Karazhan's future in World of Warcraft, if there is any.
Karazhan's basement could possibly be added in Wrath of the Lich King as an instance related to the Black Riders, or as the starting area for Death knights. There is also a door outside the Kitchen, in the area above the Stables. The door is locked and cannot be opened by any means. Looking into this room in a Map Viewer shows that it is an empty triangular room, about 10 yards in size. This also could be part of an extention to Karazhan.
Zones
There are a total of six zones within the crypts underneath Karazhan, each more gruesome than the last. The following is again, speculation, and is just information through observation.
Well of the Forgotten: This location is fairly plan, and is the first area you see as you enter. There is a tomb of unknown origins, in addition to a well that leads to the pit of criminals. It is evident that criminal corpses were tossed down the well in order to dispose of them, although the definition of "criminal" is unknown, nor if this area was under direct rule by Medivh.
The Pauper's Walk: Possibly the largest of the six zones, the Pauper's Walk extends to nearly all other areas in the crypt, and is littered with skeletons, mummified bodies, and bones. The name appears to illude to it's usage. A pauper, or literally a very poor individual, would make primary use of the area. Whether the lower class were paid to work in this psuedo-hell, or were led to their death, is unclear.
Various doors and gates appear in this area as well, all of which lead to nothing. This adds to the possibility that Blizzard has yet to finish Lower Karazhan. Many of the doors appear with odd names such as Doodad_WroughtIronDoor05, again demonstrating it's obvious incompleteness.
The Pit of Criminals: As mentioned in the previous section, the Pit of Criminals holds a massive pile of aged bones. Corpses were thrown down into the well, either to hide or to dispose of. A double staircase leads to an empty room, which through time appears to have partially caved-in.
Tome of the Unrepentant: The most confusing of areas, the Tome of the Unrepentant is a large hall with a still-water pond and multiple access points from above. A tome is a large scholarly book, and there is not a single literary work to be found.
A possible reference to Keli'dan the Breaker is made, as he drops the 
[Leggings of the Unrepentant] in heroic Blood Furnance. The connection between him and this zone is, however, unlikely.
The Upside-down Sinners: Possibly the most horrific zone in all of World of Warcraft, the Upside-down sinners is located underwater, just past the Pauper's Walk. In the murky water, chains and hooks string up men who hang with their feet to the ceiling. Their bodies untouched by time and unidentifiably mummified each retell a dark story of the games past.
This area makes the possibility of Lower Karazhan becoming an instance uncertain, as nothing this grim has ever been seen.
The Slough of Dispair: This area is a large room with nothing in it, comprising of a pit sprinkled with bones. Despite being ineventful to visit, the broadness of it's name causes it to be the most interesting. A slough contains two definitions of interest; 1) a muddy pit full of wet or soggy ground; 2) a condition of degradation, despair, or helplessness. (dictionary.com). The word "slough" quite literally describes the appearance of the room, but also oddly enough relates to the second word as well, making it "the Despair of Dispair".
Looking at the word "dispair", it first appeared to be incorrectly spelled. However, the terms dispair means the seperation of a pair.
So finally, looking at the title again, it is saying "the despair of being seperated". Perhaps married couples were killed here, or something major in lore occured at this very spot. Either way, the empty room will impress lore-fans everywhere.
Trivia
Karazhan could be based on The Dark Tower from the Stephen King novels