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Pat the shrimp dry and season with salt and pepper.
Melt the butter in a large skillet over medium-high heat. Add the zucchini and cook for 4–5 minutes, until just tender. Transfer it to a plate.
Add the shrimp to the skillet and cook for about 2 minutes per side.
Measure the shrimp at the center with a food thermometer; continue cooking until it reaches at least 63°C/145°F.
Reduce the heat to medium-low. Add the garlic and cook for 30 seconds.
Stir in the cream cheese, heavy cream, pesto, and lemon juice. Cook gently until smooth.
Return the zucchini to the skillet and toss with the sauce. Sprinkle with grated cheese and serve hot.
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