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Add the Italian sausage to a large soup pot or Dutch oven over medium heat. Cook, breaking it into bite-size pieces, until browned.
If the sausage releases a lot of grease, spoon off the excess, leaving about 1 tablespoon in the pot. If the sausage is very lean and the pot looks dry, add the olive oil.
Add the diced onion and the butter then cook for about 5 minutes, until softened.
Add the garlic, sage, thyme, and crushed red pepper flakes, if using. Cook for 1 minute, stirring frequently.
Stir in the pumpkin purée.
Slowly pour in the chicken broth, stirring until the pumpkin is completely blended into the broth.
Stir in the Better Than Bouillon vegetable base, if using.
Bring the soup to a gentle simmer and cook for 10 minutes.
Add the refrigerated cheese tortellini and cook according to the package directions, usually about 4 to 7 minutes. Keep the soup at a gentle simmer so the tortellini stays intact.
Reduce the heat to low.
Stir in the heavy cream, spinach, and Parmesan.
Cook for 1 to 2 minutes, just until the spinach is wilted and the soup is heated through.
Taste before adding salt, since the sausage, broth, bouillon, tortellini, and Parmesan all add salt.
Finish with black pepper and additional Parmesan, if desired.