Place the sausage in a large skillet or saute pan over medium heat and cook for a few minutes, breaking apart with a wooden spoon until it starts to brown a bit. Once the meat starts to break apart, add the onion and garlic and stir together. Continue to cook while breaking up meat and stirring regularly until sausage is cooked through and onions are softened.

Add the pumpkin puree and the chicken broth and stir together until the pumpkin and broth and well combined. Add the pepper, salt, marjoram, sage, cayenne and alfredo sauce and stir until the pumpkin and alfredo are well combined. Add the tortellini and stir until coated with the sauce. Cover the pan with a lid and bring heat up until you can see the sauce bubble. Reduce heat to low and simmer for 8 minutes until tortellini is cooked. Remove the lid and stir in the chopped spinach until the spinach is wilted and all ingredients are well combined.