Bring a large pot of salted water to a boil. Cook 12 ounces fettuccine according to package directions until al dente. If desired, reserve a small amount of the pasta cooking water, then drain the pasta and set aside.
While the water heats and the pasta cooks, heat 2 tablespoons butter in a large skillet over medium-high heat.
Pat 1 pound shrimp dry with paper towels. Sprinkle shrimp with 1 teaspoon Cajun seasoning and 1/2 teaspoon paprika.
Add the seasoned shrimp to the skillet in a single layer and cook until pink and opaque, about 1–2 minutes per side depending on size. Remove the shrimp with a slotted spoon and set aside.
Reduce heat to medium and add the remaining butter to the skillet. When melted, add 12 ounces sliced andouille sausage and brown, about 3–4 minutes.
Add 4 sliced green onions, 1/4 cup diced yellow pepper, 1/4 cup diced green pepper, and 1 cup sliced mushrooms to the skillet. Cook, stirring occasionally, until the vegetables are softened and the onions are translucent, about 4–5 minutes.
Stir in 4 minced garlic cloves and 1/2 cup diced tomato; cook for 1 minute more.
Pour in 1 cup heavy cream and bring to a gentle simmer. Cook, stirring occasionally, until the sauce thickens slightly, about 3–5 minutes.
Stir in 1 teaspoon lemon juice, 1/3 cup freshly grated Parmesan, and 1 tablespoon chopped fresh parsley. Stir until the Parmesan melts into the sauce. Taste and season with salt and pepper as needed.
Remove the skillet from the heat. Add the cooked fettuccine and the reserved shrimp to the skillet and toss gently to coat the pasta in the sauce. If the sauce is too thick, loosen it with a little of the reserved pasta cooking water, a splash at a time.
Serve immediately.