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Sear the shrimp. Heat a large skillet over medium-high heat and melt your butter. Add the shrimp in a single layer and season with salt and pepper. Sear for 1–2 minutes per side until just cooked through. Remove the shrimp from the pan and set aside.
Cook the aromatics. Lower the heat to medium and add the scallion whites and minced garlic to the same pan. Stir for 20–30 seconds until fragrant, being careful not to brown the garlic.
Cook the pasta. Add the dried fettuccine directly to the pan. Pour in the water, stirring to loosen any browned bits from the pan. Bring to a gentle simmer and cook, stirring occasionally, until the pasta is tender and most of the liquid has reduced half way.
Build the miso cream sauce. Lower the heat slightly. Add the heavy cream and white miso paste to the pan. Stir until the miso fully dissolves and the sauce becomes smooth and cohesive. Let the sauce gently warm and thicken for 1–2 minutes without boiling.
Finish the dish. Return the shrimp and any accumulated juices to the pan. Add the grated parmesan, green onion and lime juice and stir until the sauce becomes glossy and coats the pasta evenly. Taste and adjust seasoning with black pepper or a pinch of salt if needed.