In a large mixing bowl, soak fresh breadcrumbs in milk for about 5 minutes until absorbed. Gently mix in ground turkey, finely minced onion, garlic, chopped fresh sage, Italian seasoning, eggs, and grated Parmesan cheese, combining until just blended.

With clean hands, form the turkey mixture into meatballs, about 1.5 inches in diameter. Heat a skillet over medium heat and add a drizzle of oil. Once hot, arrange the meatballs in the skillet and pan-fry for 10–12 minutes, turning occasionally until golden brown and cooked through, reaching an internal temperature of 165°F.

In the same skillet, reduce the heat to medium-low. Pour in the pumpkin puree, heavy cream, and additional chopped sage, stirring until the mixture is smooth and heated through, around 5 minutes. Add more grated Parmesan cheese to enhance the sauce's creaminess and flavor.

Once the sauce is heated and creamy, carefully add the cooked turkey meatballs to the skillet, ensuring they are nestled in the sauce. Allow the meatballs to simmer in the pumpkin sage sauce for an additional 3–5 minutes.