Adolescent females are often environmentally exposed to pesticides by living near agricultural elds, by using pesticides at home, or by having contact with contaminated clothes and pesticide application work tools. This study assessed respiratory, hepatic, renal and hematological health disorders that might arise due to environmental exposure to pesticides among adolescent females. A cross-sectional study was conducted with 100 adolescent females environmentally exposed to pesticides who had one or more of their family members working as seasonal pesticides' applicators and 50 non-exposed (control) adolescent females from Menou a governorate, Egypt. The studied period of pesticide application season of cotton crop was from May 1 st to the end of September 2017.Participants completed a self-administered questionnaire about pesticide exposure and respiratory, hepatic, renal and hematological disorders. In addition, serum acetyl cholinesterase (AChE), spirometry, complete blood count, liver and kidney functions' tests were measured pre and post pesticide application season. The control adolescent females had a higher AChE activity, a lower prevalence of respiratory symptoms and higher means of spirometric measurements than the exposed group. During the pre and postseason, the exposed group presented a prevalence of (6%, 24%) for cough, (4%, 11%) for rhinitis, and (6%, 26%) for dyspnea during the pre and postseason; respectively. In addition, there was a decrease in means of spirometric measurements (FEV 1 %, FEV 1 /FVC%, FEF 25-75 % and PEF%) in post season compared to preseason among the exposed group. Also, there were signi cant associations between (AChE) activity and both the prevalence of respiratory manifestations and spirometric measurements among the exposed females. On the other hand, there were signi cantly increased red blood corpuscles (RBCs) and lymphocytes counts, and a signi cantly lower mean hemoglobin level among the exposed group (post season) than each of their pre-season values and the control group (P<0.05). AChE level, total protein, albumin and albumin/globulin (A/G) ratio levels were signi cantly lower, while SGPT, SGOT, and globulin, blood urea and serum creatinine mean levels were signi cantly higher among the exposed group (post season) than either of their pre-season or the control group (P<0.05). There was a positive correlation between AChE level and all studied CBC parameters for the exposed group reaching a signi cant level with basophils (P<0.05). Also, there was a negative correlation between AChE level and each of SGPT, SGOT, ALP, globulin, blood urea and serum creatinine for the exposed group reaching a signi cant level with each of SGPT and SGOT (P<0.05). At the same time, a nonsigni cant positive correlation was found between AChE level and each of total protein, albumin and A/G ratio (P>0.05). So, environmental exposure to organophosphorus pesticides has a detrimental impact on respiratory, hepatic, renal and hematological systems of adolescent females living in rural districts...